Provider Demographics
NPI:1689041030
Name:RISSLING, MICHELLE BROSEMER (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:BROSEMER
Last Name:RISSLING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GINKGO TRL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4676
Mailing Address - Country:US
Mailing Address - Phone:919-869-7654
Mailing Address - Fax:
Practice Address - Street 1:8000 REGENCY PKWY
Practice Address - Street 2:#570
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8582
Practice Address - Country:US
Practice Address - Phone:919-467-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4752103TA0700X, 103TB0200X, 103TC0700X, 103TH0004X, 103TH0100X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy