Provider Demographics
NPI:1902008188
Name:LEASE, A. MICHELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:A.
Middle Name:MICHELE
Last Name:LEASE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 ADERHOLD HALL
Mailing Address - Street 2:UNIVERSITY OF GEORGIA
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602
Mailing Address - Country:US
Mailing Address - Phone:706-542-4110
Mailing Address - Fax:706-542-4240
Practice Address - Street 1:630 ADERHOLD HALL
Practice Address - Street 2:UNIVERSITY OF GEORGIA
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602
Practice Address - Country:US
Practice Address - Phone:706-542-4110
Practice Address - Fax:706-542-4240
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002594103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical