Healthcare Provider Details

I. General information

NPI: 1013725266
Provider Name (Legal Business Name): MICHAELE NICOLE RIVERA GUERRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHAELE NICOLE RIVERA

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 DENIM DR
ERWIN NC
28339-2204
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 910-230-4011
  • Fax: 910-660-0948
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018964
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: