Provider Demographics
NPI:1417275678
Name:MISENHEIMER, AUDRA GRIFFIN (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:GRIFFIN
Last Name:MISENHEIMER
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:NC
Mailing Address - Zip Code:28124-7809
Mailing Address - Country:US
Mailing Address - Phone:704-436-6534
Mailing Address - Fax:
Practice Address - Street 1:8555 NORTH DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:NC
Practice Address - Zip Code:28124-7809
Practice Address - Country:US
Practice Address - Phone:704-436-6534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7431101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool