Provider Demographics
NPI:1568024701
Name:FORSYTHE, MICHAELA (LCMHC, LCAS, CSI)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:FORSYTHE
Suffix:
Gender:F
Credentials:LCMHC, LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 BRASWELL RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-8568
Mailing Address - Country:US
Mailing Address - Phone:919-221-7883
Mailing Address - Fax:
Practice Address - Street 1:696 N SPENCE AVE STE A
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4354
Practice Address - Country:US
Practice Address - Phone:919-330-4147
Practice Address - Fax:919-330-4142
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25188101YA0400X
NCA14654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)