Provider Demographics
NPI:1700577376
Name:LEYDEN, MICHELLE YVETTE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YVETTE
Last Name:LEYDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 SAINT FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2554
Mailing Address - Country:US
Mailing Address - Phone:678-231-1521
Mailing Address - Fax:
Practice Address - Street 1:1429 SAINT FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-2554
Practice Address - Country:US
Practice Address - Phone:678-231-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health