Provider Demographics
NPI:1497368096
Name:DAMERON, MICHELLE YVETTE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YVETTE
Last Name:DAMERON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5936
Mailing Address - Country:US
Mailing Address - Phone:252-355-2801
Mailing Address - Fax:
Practice Address - Street 1:108 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5936
Practice Address - Country:US
Practice Address - Phone:252-355-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health