Provider Demographics
NPI:1336628759
Name:HOLLEMAN, MICHELLE ROSES (MS, LCASA, ASAT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROSES
Last Name:HOLLEMAN
Suffix:
Gender:F
Credentials:MS, LCASA, ASAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 WILGROVE MINT HILL RD STE B6
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3500
Mailing Address - Country:US
Mailing Address - Phone:704-301-4958
Mailing Address - Fax:
Practice Address - Street 1:4614 WILGROVE MINT HILL RD STE B6
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3500
Practice Address - Country:US
Practice Address - Phone:704-236-5994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24812101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty