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Organization
MICUM HEALTH PLLC
Active
Organization
MICUM HEALTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOVAKYSHE WOULLARD LCSW, LCAS-A, CADC (PROGRAM DIRECTOR)
(800) 470-8303
Entity
Organization
Contact information
Practice address
10130 MALLARD CREEK RD STE 207, CHARLOTTE, NC 28262-6003
(800) 470-8303
(704) 997-1588
Mailing address
4311 SCHOOL HOUSE CMNS # 174, HARRISBURG, NC 28075-7510
(800) 470-8303
(704) 997-1588
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
08/17/2023
Last updated
06/20/2024
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