Provider Demographics
NPI:1639889439
Name:MISHENKO, MICHELLE PAMELA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PAMELA
Last Name:MISHENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HOLLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9423
Mailing Address - Country:US
Mailing Address - Phone:919-428-7746
Mailing Address - Fax:919-289-1345
Practice Address - Street 1:113 HOLLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9423
Practice Address - Country:US
Practice Address - Phone:919-428-7746
Practice Address - Fax:919-289-1345
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0185301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical