Provider Demographics
NPI:1376822403
Name:TYNDLE, MICHELLE ANGELIC (MA, LPCA, NCC, LCAS-)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:ANGELIC
Last Name:TYNDLE
Suffix:
Gender:F
Credentials:MA, LPCA, NCC, LCAS-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5114
Mailing Address - Country:US
Mailing Address - Phone:704-355-5021
Mailing Address - Fax:
Practice Address - Street 1:720 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5114
Practice Address - Country:US
Practice Address - Phone:704-355-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0000101YA0400X
NCA8494101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)