MEDICARE: MICHELLE SEAGLE-AMAYA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1417810029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SEAGLE-AMAYA

Provider Business Mailing Address
First Line	:	5308 RIVER RIDGE DR
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-7063
Country	:	US
Telephone Number	:	678-978-9621
Fax Number	:

Provider Business Practice Location Address
First Line	:	5308 RIVER RIDGE DR
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-7063
Country	:	US
Telephone Number	:	678-978-9621
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ MICHELLE SEAGLE-AMAYA ” Practice Location

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