Provider Demographics
NPI:1245652288
Name:ROY, MICHELLE BATES
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BATES
Last Name:ROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4634 HARMONY LN
Mailing Address - Street 2:
Mailing Address - City:EFLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27243-9456
Mailing Address - Country:US
Mailing Address - Phone:919-742-0919
Mailing Address - Fax:984-217-0009
Practice Address - Street 1:201 N HOLLAND POINT DR
Practice Address - Street 2:
Practice Address - City:STELLA
Practice Address - State:NC
Practice Address - Zip Code:28582-9604
Practice Address - Country:US
Practice Address - Phone:910-476-1288
Practice Address - Fax:984-217-0009
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0135664103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst