Provider Demographics
NPI:1609265099
Name:GIRARD, MICHELE A (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:GIRARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25505
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5008
Mailing Address - Country:US
Mailing Address - Phone:347-357-1009
Mailing Address - Fax:
Practice Address - Street 1:429 PERSON ST STE 12
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5737
Practice Address - Country:US
Practice Address - Phone:910-663-1459
Practice Address - Fax:910-321-8789
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089429-1104100000X
FLSW138871041C0700X
NCC0106171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker