Healthcare Provider Details

I. General information

NPI: 1639501042
Provider Name (Legal Business Name): MICHELLE DELELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 04/14/2016
Certification Date:
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 SUITE 100
CONCORD NC
28025-1831
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-3616
  • Fax: 704-636-8818
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 NumberP009643
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP009463
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: