Provider Demographics
NPI:1225290075
Name:NEEDHAM, MICHELLE JOANNE
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JOANNE
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8692 HICKORY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-6871
Mailing Address - Country:US
Mailing Address - Phone:562-922-5065
Mailing Address - Fax:
Practice Address - Street 1:8692 HICKORY CREEK CT
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-6871
Practice Address - Country:US
Practice Address - Phone:562-922-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CALMFT9842106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner