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General NPI Number Information
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NPI Number | 1679660666
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Entity Type | Organization
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Legal Business Name | MICHAEL W. MCNULTY, LPC, LLC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/21/2022
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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 | SOLE PROPRIETOR
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Name | MR. MICHAEL WAYNE MCNULTY
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Credential | LPC
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Telephone | 770-289-8217
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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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