MEDICARE: CAROLINA COGNITIVE AND BEHAVIORAL HEALTH CLINIC, PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1518826411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA COGNITIVE AND BEHAVIORAL HEALTH CLINIC, PLLC

Provider Business Mailing Address
First Line	:	300 S MAIN ST STE 212
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-4201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S MAIN ST STE 212
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-4201
Country	:	US
Telephone Number	:	984-400-2048
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBER
Name	:	JAIME HAVAH ELIANA MICHAELS
Credential	:	DNP, MSN, PMHNP-BC
Telephone Number	:	984-400-2048

Provider Enumeration Date	:	01/17/2026
Last Update Date	:	03/16/2026

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