Provider Demographics
NPI:1760423925
Name:MICHAEL, DAVID EDWARD (MA, LPC, LPCS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EDWARD
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:MA, LPC, LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29054-0284
Mailing Address - Country:US
Mailing Address - Phone:803-528-8939
Mailing Address - Fax:
Practice Address - Street 1:605 HALLMAN WAGON RD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-8987
Practice Address - Country:US
Practice Address - Phone:803-528-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4355101YM0800X
SC5174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional