Healthcare Provider Details

I. General information

NPI: 1972502821
Provider Name (Legal Business Name): MICHELLE PRINCE LUKSE LPC, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 COLWICK RD SUITE 705
CHARLOTTE NC
28211-2349
US

IV. Provider business mailing address

10818 KENDERLY CT
CHARLOTTE NC
28277-2122
US

V. Phone/Fax

Practice location:
  • Phone: 704-362-0099
  • Fax:
Mailing address:
  • Phone: 704-542-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNC LPC 964
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: