Provider Demographics
NPI:1801305339
Name:FORD, MICHELLE AVARY (LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:AVARY
Last Name:FORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:MICHELLE
Other - Last Name:AVARY-FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:111 DEARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560
Mailing Address - Country:US
Mailing Address - Phone:228-547-2713
Mailing Address - Fax:
Practice Address - Street 1:111 DEARMAN AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-5909
Practice Address - Country:US
Practice Address - Phone:228-547-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional