Healthcare Provider Details

I. General information

NPI: 1326902834
Provider Name (Legal Business Name): MIRELLE CHATEIGNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 DURHAM RD STE B
WAKE FOREST NC
27587-3301
US

IV. Provider business mailing address

205 IRONWOOD BLVD
YOUNGSVILLE NC
27596-4506
US

V. Phone/Fax

Practice location:
  • Phone: 919-891-0521
  • Fax:
Mailing address:
  • Phone: 619-925-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number10629A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: