Provider Demographics
NPI:1104637040
Name:MEJIA, MICHELLE (LAC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 HARRISON GDNS
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1615
Mailing Address - Country:US
Mailing Address - Phone:862-334-0141
Mailing Address - Fax:
Practice Address - Street 1:530 UNION AVE STE 3A
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1934
Practice Address - Country:US
Practice Address - Phone:908-213-5594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00686100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health