Provider Demographics
NPI:1134273030
Name:BALDWIN, MICHELLE MUNSON
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MUNSON
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ROANN
Other - Last Name:MUNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LCAS
Mailing Address - Street 1:5 NEW BERN DR
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-8539
Mailing Address - Country:US
Mailing Address - Phone:828-681-9658
Mailing Address - Fax:
Practice Address - Street 1:120 CHADWICK SQUARE CT STE C
Practice Address - Street 2:NC MENTOR
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-3200
Practice Address - Country:US
Practice Address - Phone:828-696-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC656101YA0400X
NC3023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102810Medicaid