Provider Demographics
NPI:1790925949
Name:DRENNAN, MICHAEL RAY (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAY
Last Name:DRENNAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 CHEROKEE ST. NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6523
Mailing Address - Country:US
Mailing Address - Phone:707-424-2250
Mailing Address - Fax:
Practice Address - Street 1:3131 CHEROKEE ST NW STE B3
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2897
Practice Address - Country:US
Practice Address - Phone:770-424-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-01
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004916101YP2500X
GA004916101YP2500X
CO418101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional