Provider Demographics
NPI:1477946960
Name:YOW, MICHAEL (LCAS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:YOW
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 OLD SALEM RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5268
Mailing Address - Country:US
Mailing Address - Phone:336-546-6304
Mailing Address - Fax:
Practice Address - Street 1:426 OLD SALEM RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5268
Practice Address - Country:US
Practice Address - Phone:336-546-6304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC588101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor