Healthcare Provider Details

I. General information

NPI: 1386422566
Provider Name (Legal Business Name): MICHELLE KRISTINE VICKERS LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 S FAYETTEVILLE ST
ASHEBORO NC
27203-6488
US

IV. Provider business mailing address

2215 SHADOW VALLEY RD APT F
HIGH POINT NC
27265-2783
US

V. Phone/Fax

Practice location:
  • Phone: 336-628-0109
  • Fax:
Mailing address:
  • Phone: 336-247-6179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC-30130
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23087
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: