Provider Demographics
NPI:1104201748
Name:MURDOCK, MICHELLE L (LCMHCS, CSOTS, CPSS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:LCMHCS, CSOTS, CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 HUFFMAN MILL RD APT M5
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5135
Mailing Address - Country:US
Mailing Address - Phone:919-519-6286
Mailing Address - Fax:919-584-8170
Practice Address - Street 1:1045 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5045
Practice Address - Country:US
Practice Address - Phone:336-270-6116
Practice Address - Fax:844-272-1223
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21357101YA0400X
NC13905101YM0800X, 101YP2500X
NCQS128183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health