Provider Demographics
NPI:1013112879
Name:NEIDIG, MICHAEL DAVID (LCSW, LCAS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:NEIDIG
Suffix:
Gender:M
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 EMERALD LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28741-8891
Mailing Address - Country:US
Mailing Address - Phone:828-524-3268
Mailing Address - Fax:828-349-6039
Practice Address - Street 1:50 EMERALD LN
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28741-8891
Practice Address - Country:US
Practice Address - Phone:828-524-3268
Practice Address - Fax:828-349-6039
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0015671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003099Medicaid
NC2872623BMedicare ID - Type Unspecified