Provider Demographics
NPI:1437197134
Name:KANE, MICHELLE ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:KANE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:ELIZABETH
Other - Last Name:LUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:7 CORPORATE CENTER CT STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3839
Mailing Address - Country:US
Mailing Address - Phone:336-604-2789
Mailing Address - Fax:336-282-3797
Practice Address - Street 1:7 CORPORATE CENTER CT STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-3839
Practice Address - Country:US
Practice Address - Phone:336-604-2789
Practice Address - Fax:336-282-3797
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2543103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1242LOtherBCBS NC
NC891242LMedicaid
NC7969584OtherAETNA
NC95152OtherMEDCOST
NC891242LMedicaid