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General NPI Number Information
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NPI Number | 1700677721
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Entity Type | Individual
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Provider Name | MICHAELENE MCGINNIS LPC
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Gender | Female
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 1626 FREDERICA RD STE 203
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City | SAINT SIMONS IS
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State | GA
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Zip | 31522-2526
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Country | US
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Telephone | 616-498-1948
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Fax |
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Provider Business Mailing Address
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Address Line | 143 KILN TRL
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City | SAINT SIMONS IS
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State | GA
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Zip | 31522-5535
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Country | US
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Telephone |
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Fax |
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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 | LPC015574
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License Number State | GA
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