Provider Demographics
NPI:1053192468
Name:RICH, MICHELLE (LPA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BORDEAUX DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-3399
Mailing Address - Country:US
Mailing Address - Phone:919-885-6515
Mailing Address - Fax:
Practice Address - Street 1:201 W ASH ST STE 2
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3665
Practice Address - Country:US
Practice Address - Phone:919-330-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5523103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist