Healthcare Provider Details

I. General information

NPI: 1265349393
Provider Name (Legal Business Name): MICHELLE SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6912 NELLORE ST
GREENSBORO NC
27405-8900
US

IV. Provider business mailing address

6912 NELLORE ST
GREENSBORO NC
27405-8900
US

V. Phone/Fax

Practice location:
  • Phone: 336-509-3733
  • Fax:
Mailing address:
  • Phone: 336-509-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: