Provider Demographics
NPI:1558434753
Name:LIKEN, MICHELLE A (PHD, RN, CS, CCM)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:A
Last Name:LIKEN
Suffix:
Gender:F
Credentials:PHD, RN, CS, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MILES PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-3289
Mailing Address - Country:US
Mailing Address - Phone:803-788-0400
Mailing Address - Fax:803-788-4341
Practice Address - Street 1:113 MILES PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-3289
Practice Address - Country:US
Practice Address - Phone:803-788-0400
Practice Address - Fax:803-788-4341
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR 73981171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator