Provider Demographics
NPI:1811227812
Name:GODFREY, MICHAEL-RENEE (LPC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL-RENEE
Middle Name:
Last Name:GODFREY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MICHAEL-RENEE
Other - Middle Name:GODFREY
Other - Last Name:ASTREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAPC
Mailing Address - Street 1:1949 SEYMOUR DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8067
Mailing Address - Country:US
Mailing Address - Phone:678-398-7224
Mailing Address - Fax:844-398-7224
Practice Address - Street 1:1949 SEYMOUR DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8067
Practice Address - Country:US
Practice Address - Phone:678-398-7224
Practice Address - Fax:844-398-7224
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC001641101YP2500X
GALPC006036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA498827642BMedicaid