Provider Demographics
NPI:1801207337
Name:MCMICHAEL, KATRINA SHEALY (MS)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:SHEALY
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:LEE
Other - Last Name:SHEALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1741 SHIVERS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5413
Mailing Address - Country:US
Mailing Address - Phone:803-896-0172
Mailing Address - Fax:
Practice Address - Street 1:1741 SHIVERS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5413
Practice Address - Country:US
Practice Address - Phone:803-896-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist