Provider Demographics
NPI:1134813306
Name:YORK, MICHAELA DENISE
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:DENISE
Last Name:YORK
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 1:698 PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-1040
Mailing Address - Country:US
Mailing Address - Phone:910-992-1426
Mailing Address - Fax:
Practice Address - Street 1:753 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3238
Practice Address - Country:US
Practice Address - Phone:910-490-2037
Practice Address - Fax:910-479-1711
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0206381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical