Provider Demographics
NPI:1700687431
Name:SONG, MICHELLE (LAPC, MSED)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:LAPC, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 SOUTH ST UNIT 605
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1636
Mailing Address - Country:US
Mailing Address - Phone:551-250-6098
Mailing Address - Fax:
Practice Address - Street 1:1518 WALNUT ST STE 1100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3406
Practice Address - Country:US
Practice Address - Phone:410-608-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health