Provider Demographics
NPI:1013934090
Name:MCNULTY, MICHAEL WAYNE (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:MCNULTY
Suffix:
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 1:2330 SCENIC HWY S STE 204
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3115
Mailing Address - Country:US
Mailing Address - Phone:770-289-8217
Mailing Address - Fax:888-502-0589
Practice Address - Street 1:2330 SCENIC HWY S STE 204
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3115
Practice Address - Country:US
Practice Address - Phone:770-289-8217
Practice Address - Fax:888-502-0589
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC000664101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health