Healthcare Provider Details

I. General information

NPI: 1881423028
Provider Name (Legal Business Name): MICHELLE LADEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3459 ACWORTH DUE WEST RD NW STE 206
ACWORTH GA
30101-5821
US

IV. Provider business mailing address

3459 ACWORTH DUE WEST RD NW STE 206
ACWORTH GA
30101-5821
US

V. Phone/Fax

Practice location:
  • Phone: 770-892-6287
  • Fax:
Mailing address:
  • Phone: 770-892-6287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC017516
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: