Provider Demographics
NPI:1205978061
Name:WORRIX, MICHAELE LYNN (LPC, ATR)
Entity type:Individual
Prefix:
First Name:MICHAELE
Middle Name:LYNN
Last Name:WORRIX
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2056
Mailing Address - Country:US
Mailing Address - Phone:919-818-4630
Mailing Address - Fax:919-285-4964
Practice Address - Street 1:1000 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2056
Practice Address - Country:US
Practice Address - Phone:919-285-4963
Practice Address - Fax:919-285-4964
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC148NGOtherBLUE CROSS BLUE SHIELD
NC6103345Medicaid