Provider Demographics
NPI:1134303803
Name:NORVILLE, MICHELLE MARIE (MA,LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:NORVILLE
Suffix:
Gender:F
Credentials:MA,LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N. RICHMOND STREET
Mailing Address - Street 2:ENTRANCE C
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1148
Mailing Address - Country:US
Mailing Address - Phone:920-730-1326
Mailing Address - Fax:920-734-2824
Practice Address - Street 1:3003 N RICHMOND STREET
Practice Address - Street 2:ENTRANCE C
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1148
Practice Address - Country:US
Practice Address - Phone:920-730-1326
Practice Address - Fax:920-734-2824
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3895-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3895-125OtherLPC
WI43745800Medicaid