Provider Demographics
NPI:1619725462
Name:MICHEL, FABIENNE (LMSW)
Entity type:Individual
Prefix:
First Name:FABIENNE
Middle Name:
Last Name:MICHEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SCENIC HWY # 1701-265
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-6359
Mailing Address - Country:US
Mailing Address - Phone:347-307-0597
Mailing Address - Fax:
Practice Address - Street 1:1903 WILSON MANOR CIR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3742
Practice Address - Country:US
Practice Address - Phone:347-307-0597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801118109104100000X
GAMSW005735104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker