Healthcare Provider Details

I. General information

NPI: 1942872973
Provider Name (Legal Business Name): MICHELLE LEE PREVOT MS, APC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1978 GARDEN HILLS LOOP
RICHMOND HILL GA
31324-6066
US

IV. Provider business mailing address

1978 GARDEN HILLS LOOP
RICHMOND HILL GA
31324-6066
US

V. Phone/Fax

Practice location:
  • Phone: 386-503-6218
  • Fax:
Mailing address:
  • Phone: 386-503-6218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC007875
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: