Provider Demographics
NPI:1285887794
Name:FREY, MICHELE R (PHD, LPC, LPC-S)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:R
Last Name:FREY
Suffix:
Gender:F
Credentials:PHD, LPC, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 LM WIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-1073
Mailing Address - Country:US
Mailing Address - Phone:770-445-1697
Mailing Address - Fax:
Practice Address - Street 1:237 LM WIGLEY RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-1073
Practice Address - Country:US
Practice Address - Phone:770-445-1697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC0003697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202279701OtherEIN