Healthcare Provider Details

I. General information

NPI: 1881477743
Provider Name (Legal Business Name): MICHELLE MACKENZIE WHITE LCMHC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 STATESVILLE BLVD
SALISBURY NC
28147-1411
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 704-633-3616
  • Fax:
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA19052
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: