Healthcare Provider Details

I. General information

NPI: 1033645163
Provider Name (Legal Business Name): MR. ANDREW ROBERT MICHAELS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 MARGARITA DR UNIT 8201
MYRTLE BEACH SC
29577-2053
US

IV. Provider business mailing address

2320 MARGARITA DR UNIT 8201
MYRTLE BEACH SC
29577-2053
US

V. Phone/Fax

Practice location:
  • Phone: 516-637-9204
  • Fax:
Mailing address:
  • Phone: 516-637-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007765
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7232
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: