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General NPI Number Information
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NPI Number | 1013934090
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Entity Type | Individual
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Provider Name | MICHAEL WAYNE MCNULTY LPC
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Gender | Male
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 2330 SCENIC HWY S STE 204
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City | SNELLVILLE
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State | GA
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Zip | 30078-3115
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Country | US
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Telephone | 770-289-8217
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Fax | 888-502-0589
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Provider Business Mailing Address
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Address Line | 2330 SCENIC HWY S STE 204
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City | SNELLVILLE
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State | GA
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Zip | 30078-3115
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Country | US
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Telephone | 770-289-8217
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Fax | 888-502-0589
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC000664
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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