Provider Demographics
NPI:1275677791
Name:THERRIEN, MICHELINA H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELINA
Middle Name:H
Last Name:THERRIEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 PINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7921
Mailing Address - Country:US
Mailing Address - Phone:386-972-0677
Mailing Address - Fax:910-353-7365
Practice Address - Street 1:893 PINE VALLEY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7921
Practice Address - Country:US
Practice Address - Phone:386-972-0677
Practice Address - Fax:910-353-7365
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW64231041C0700X
NCC0054741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical