Provider Demographics
NPI:1851524649
Name:PATTERSON, MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2528
Mailing Address - Country:US
Mailing Address - Phone:678-787-4350
Mailing Address - Fax:888-388-9622
Practice Address - Street 1:1200 ABERNATHY RD NE
Practice Address - Street 2:SUITE 1700
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5662
Practice Address - Country:US
Practice Address - Phone:770-350-2617
Practice Address - Fax:888-388-9622
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0030371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical