Healthcare Provider Details

I. General information

NPI: 1447303524
Provider Name (Legal Business Name): SHERI MICHELLE SIEGEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 CHURCH ST NE STE 295
MARIETTA GA
30060-1608
US

IV. Provider business mailing address

145 CHURCH ST NE STE 295
MARIETTA GA
30060-1608
US

V. Phone/Fax

Practice location:
  • Phone: 770-428-7395
  • Fax: 770-428-1964
Mailing address:
  • Phone: 770-428-7395
  • Fax: 770-428-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1587
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: