Provider Demographics
NPI:1245652957
Name:UNDERDUE, MICHELLE ANNETTE (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNETTE
Last Name:UNDERDUE
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 EAST MAIN STREET
Mailing Address - Street 2:SUITE 2-120
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701
Mailing Address - Country:US
Mailing Address - Phone:919-682-5300
Mailing Address - Fax:919-682-5322
Practice Address - Street 1:801 EAST MAIN STREET
Practice Address - Street 2:SUITE 2-120
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701
Practice Address - Country:US
Practice Address - Phone:919-682-5300
Practice Address - Fax:919-682-5322
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0081981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical