Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY004294 | GA |
Y | 103TC0700X | Clinical Psychologist | PSY004294 | GA |
N | 103TR0400X | Rehabilitation Psychologist | PSY004294 | GA |
NPI | 1205290491 |
---|---|
Provider Name | Michelle Mary Haddad |
First Address | Atlanta, GA 30322-1004 |
Second Address | Atlanta, GA 30322-6560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2016 |
Last Update Date | 30/05/2019 |