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General NPI Number Information
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NPI Number | 1750875886
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Entity Type | Individual
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Provider Name | MICHELLE DENISE BETHUNE MSW
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Gender | Female
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 2795 MAIN ST W
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City | SNELLVILLE
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State | GA
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Zip | 30078-3164
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Country | US
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Telephone | 678-344-7836
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Fax |
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Provider Business Mailing Address
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Address Line | 5207 SITKA WAY
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City | NORCROSS
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State | GA
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Zip | 30093-2462
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Country | US
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Telephone | 206-841-2213
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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