MEDICARE: MICHAELE LYNN WORRIX LPC, ATR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5252	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	148NG	OTHER	NC	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205978061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELE LYNN WORRIX LPC, ATR

Provider Business Mailing Address
First Line	:	1000 N MAIN ST
Second Line	:	SUITE 202
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-2056
Country	:	US
Telephone Number	:	919-818-4630
Fax Number	:	919-285-4964

Provider Business Practice Location Address
First Line	:	1000 N MAIN ST
Second Line	:	SUITE 202
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-2056
Country	:	US
Telephone Number	:	919-285-4963
Fax Number	:	919-285-4964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	10/31/2008

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