Provider Demographics
NPI:1679009690
Name:JUAREZ, MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 GREENBRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0614
Mailing Address - Country:US
Mailing Address - Phone:757-932-0040
Mailing Address - Fax:844-526-9334
Practice Address - Street 1:1403 GREENBRIER PKWY STE 150
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0624
Practice Address - Country:US
Practice Address - Phone:757-788-0300
Practice Address - Fax:757-788-0969
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional