Provider Demographics
NPI:1659915296
Name:KANNER, MICHAEL (LAPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KANNER
Suffix:
Gender:M
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MAXWELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2031
Mailing Address - Country:US
Mailing Address - Phone:404-200-2323
Mailing Address - Fax:
Practice Address - Street 1:316 MAXWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2031
Practice Address - Country:US
Practice Address - Phone:404-200-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health