Provider Demographics
NPI:1588326359
Name:WIERSON, MICHELLE HARRIS (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:HARRIS
Last Name:WIERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1514
Mailing Address - Country:US
Mailing Address - Phone:404-731-2999
Mailing Address - Fax:
Practice Address - Street 1:1138 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:AVONDALE ESTATES
Practice Address - State:GA
Practice Address - Zip Code:30002-1514
Practice Address - Country:US
Practice Address - Phone:404-731-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical