Healthcare Provider Details

I. General information

NPI: 1194274399
Provider Name (Legal Business Name): MICHELLE PETTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE KRAFT

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 RIVERWALK PKWY STE 201
ROCK HILL SC
29730-0243
US

IV. Provider business mailing address

528 GENTLE BREEZE LN
ROCK HILL SC
29730-7817
US

V. Phone/Fax

Practice location:
  • Phone: 803-335-0718
  • Fax: 803-335-0719
Mailing address:
  • Phone: 586-627-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87640
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: