Provider Demographics
NPI:1629882345
Name:HEADLIE, MICHELLE H (CD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:H
Last Name:HEADLIE
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:NC
Mailing Address - Zip Code:28682-8760
Mailing Address - Country:US
Mailing Address - Phone:617-820-4133
Mailing Address - Fax:
Practice Address - Street 1:8117 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:NC
Practice Address - Zip Code:28682-8760
Practice Address - Country:US
Practice Address - Phone:617-820-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171400000X
MA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No171400000XOther Service ProvidersHealth & Wellness Coach