Provider Demographics
NPI:1831643808
Name:ARNOLD, MICHAEL DUSTIN (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DUSTIN
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:DUSTY
Other - Middle Name:
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:275 PINEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-4484
Mailing Address - Country:US
Mailing Address - Phone:912-282-0992
Mailing Address - Fax:912-285-8817
Practice Address - Street 1:709 BLACKSHEAR HWY STE C
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-8870
Practice Address - Country:US
Practice Address - Phone:912-937-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010540101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional