Provider Demographics
NPI:1255601563
Name:MICHELSEN, TONI (LCPC)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:
Last Name:MICHELSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 HARBOUR GLEN CT.
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2268
Mailing Address - Country:US
Mailing Address - Phone:410-647-8066
Mailing Address - Fax:
Practice Address - Street 1:1234 HARBOUR GLEN CT.
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2268
Practice Address - Country:US
Practice Address - Phone:410-647-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional