Healthcare Provider Details

I. General information

NPI: 1417173428
Provider Name (Legal Business Name): MICHAEL A. FRAZIER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 POWERS FERRY RD SE SUITE 200
ATLANTA GA
30339-5621
US

IV. Provider business mailing address

8114 VINCENT MILL DR
DOUGLASVILLE GA
30134-6476
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-4744
  • Fax: 770-953-4640
Mailing address:
  • Phone: 678-697-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004046
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: