Provider Demographics
NPI:1689801987
Name:NIX, MICHELLE A (LAPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:NIX
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 GARDEN WALK BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2628
Mailing Address - Country:US
Mailing Address - Phone:770-991-7420
Mailing Address - Fax:770-991-7429
Practice Address - Street 1:6315 GARDEN WALK BLVD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2628
Practice Address - Country:US
Practice Address - Phone:770-991-7420
Practice Address - Fax:770-991-7429
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002162101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional