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General NPI Number Information
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NPI Number | 1730420340
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Entity Type | Individual
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Provider Name | MICHELLE R. HENRIQUES PH.D., LCSW, LCDC
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Gender | Female
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 6600 VAN AALST BLVD
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City | FORT MOORE
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State | GA
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Zip | 31905-2102
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Country | US
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Telephone | 404-644-1225
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Fax |
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Provider Business Mailing Address
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Address Line | 71 PORTICO PL
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City | NEWNAN
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State | GA
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Zip | 30265-5944
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Country | US
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Telephone | 404-644-1225
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 11588
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW23402
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 55290
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License Number State | TX
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