Provider Demographics
NPI:1922303858
Name:CREEKMORE, MICHAEL E JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:CREEKMORE
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 LAKE PARK DRIVE, SW
Mailing Address - Street 2:APT. L
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:678-293-5529
Mailing Address - Fax:
Practice Address - Street 1:2141 LAKE PARK DR SE
Practice Address - Street 2:APARTMENT L
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7733
Practice Address - Country:US
Practice Address - Phone:678-293-5529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional