Provider Demographics
NPI:1215324397
Name:BORDEAU, MICHEL (MA, LCSW)
Entity type:Individual
Prefix:
First Name:MICHEL
Middle Name:
Last Name:BORDEAU
Suffix:
Gender:M
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 SUMMIT LN # 1042
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-8728
Mailing Address - Country:US
Mailing Address - Phone:404-798-9799
Mailing Address - Fax:
Practice Address - Street 1:968 SUMMIT LN # 1042
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8728
Practice Address - Country:US
Practice Address - Phone:404-798-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0064891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical