Provider Demographics
NPI:1336966878
Name:COLSON, MICHELLE COREY (MA, LPCA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:COREY
Last Name:COLSON
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 SORANO ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-8028
Mailing Address - Country:US
Mailing Address - Phone:252-314-2242
Mailing Address - Fax:
Practice Address - Street 1:3691 PALMETTO POINTE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-1202
Practice Address - Country:US
Practice Address - Phone:843-962-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional