Provider Demographics
NPI:1679282271
Name:DE LA CRUZ, MICHELE A. (MHS, MPP,PHD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE A.
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:MHS, MPP,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6969 GALLANT CIR SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-4683
Mailing Address - Country:US
Mailing Address - Phone:229-443-5190
Mailing Address - Fax:
Practice Address - Street 1:6969 GALLANT CIR SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-4683
Practice Address - Country:US
Practice Address - Phone:229-443-5190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5225101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor