Provider Demographics
NPI:1295506350
Name:COLON, MICHAEL (MA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:COLON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 MISSION DR SE
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:GA
Mailing Address - Zip Code:31305-4941
Mailing Address - Country:US
Mailing Address - Phone:912-222-8128
Mailing Address - Fax:
Practice Address - Street 1:3441 CYPRESS MILL RD STE 101
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-2879
Practice Address - Country:US
Practice Address - Phone:912-483-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional