Provider Demographics
NPI:1235360090
Name:MATTOX, MICHELE YORK (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:YORK
Last Name:MATTOX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:M
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 NEW BERN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1231
Mailing Address - Country:US
Mailing Address - Phone:919-350-8669
Mailing Address - Fax:919-350-8677
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-350-8669
Practice Address - Fax:919-350-8677
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0062291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical