Provider Demographics
NPI:1144305590
Name:MORANCIE, MICHELLE DENISE (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DENISE
Last Name:MORANCIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 ROSWELL RD APT I10
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2476
Mailing Address - Country:US
Mailing Address - Phone:917-991-4146
Mailing Address - Fax:
Practice Address - Street 1:6851 ROSWELL RD APT I10
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-2476
Practice Address - Country:US
Practice Address - Phone:917-991-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012342103T00000X, 103TS0200X
GAPSY003862103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool