Provider Demographics
NPI:1447303524
Name:SIEGEL, SHERI MICHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHERI
Middle Name:MICHELLE
Last Name:SIEGEL
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 1:145 CHURCH ST NE STE 295
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1608
Mailing Address - Country:US
Mailing Address - Phone:770-428-7395
Mailing Address - Fax:770-428-1964
Practice Address - Street 1:145 CHURCH ST NE STE 295
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1608
Practice Address - Country:US
Practice Address - Phone:770-428-7395
Practice Address - Fax:770-428-1964
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1587103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00493655BMedicaid