Provider Demographics
NPI:1952393308
Name:O'LEARY, MICHAL ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAL
Middle Name:ANN
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MICKY
Other - Middle Name:
Other - Last Name:O'LEARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1945 MASON MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4006
Mailing Address - Country:US
Mailing Address - Phone:404-818-6539
Mailing Address - Fax:404-321-4887
Practice Address - Street 1:1945 MASON MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4006
Practice Address - Country:US
Practice Address - Phone:404-818-6539
Practice Address - Fax:404-321-4887
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002239103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBFSNMedicare ID - Type UnspecifiedPSYCHOLOGIST