Healthcare Provider Details

I. General information

NPI: 1154668382
Provider Name (Legal Business Name): MICHELLE IVY GREENSPOON BARRETT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE IVY GREENSPOON MA

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 12/09/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VEAZEY DR
BUTNER NC
27509-1668
US

IV. Provider business mailing address

8516 BELL GROVE WAY
RALEIGH NC
27615-3183
US

V. Phone/Fax

Practice location:
  • Phone: 919-764-2000
  • Fax:
Mailing address:
  • Phone: 805-252-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5501
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: