Provider Demographics
NPI:1366465320
Name:DEINISH, MICHELE A (MS, LCMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:A
Last Name:DEINISH
Suffix:
Gender:F
Credentials:MS, LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WESTOVER DR # 10026
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-8941
Mailing Address - Country:US
Mailing Address - Phone:910-375-1518
Mailing Address - Fax:800-991-2996
Practice Address - Street 1:500 WESTOVER DR
Practice Address - Street 2:#10026
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330
Practice Address - Country:US
Practice Address - Phone:910-375-1518
Practice Address - Fax:800-991-2996
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8833101YM0800X, 101YP1600X, 101YP2500X
MDLC2382101YP2500X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral