Provider Demographics
NPI:1841994134
Name:MICHAEL, VALERIE R (CADC-II)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:R
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 JONESBORO RD STE A7
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2401
Mailing Address - Country:US
Mailing Address - Phone:770-629-2088
Mailing Address - Fax:770-216-1576
Practice Address - Street 1:194 JONESBORO RD STE A7
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2401
Practice Address - Country:US
Practice Address - Phone:770-629-2088
Practice Address - Fax:770-216-1576
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01652101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)