Provider Demographics
NPI:1457864084
Name:MIRACLE-HUIE, JAY LINDAY (LCSWA)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:LINDAY
Last Name:MIRACLE-HUIE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:L
Other - Last Name:MIRACLE-HUIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWA
Mailing Address - Street 1:3000 HIGHWOODS BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1029
Mailing Address - Country:US
Mailing Address - Phone:919-504-6314
Mailing Address - Fax:
Practice Address - Street 1:3000 HIGHWOODS BLVD STE 310
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1029
Practice Address - Country:US
Practice Address - Phone:919-504-6314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-17-43125106S00000X
NCP0143071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty