Provider Demographics
NPI:1245350529
Name:LAWWILL, MICHAEL L (LMFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:LAWWILL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13030 CRABAPPLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4261
Mailing Address - Country:US
Mailing Address - Phone:770-641-7680
Mailing Address - Fax:770-641-7680
Practice Address - Street 1:1014 CANTON ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3615
Practice Address - Country:US
Practice Address - Phone:770-993-2676
Practice Address - Fax:770-641-7680
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
481288787OtherTAX ID