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Individual
MICHELLE JACKSON BRICE
Active
Individual
MICHELLE JACKSON BRICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, LCAS-A
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-21818
NC
1041C0700X
Clinical Social Worker
Primary
C010980
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497260657
—
NC
01
—
19UR4Q
BCBS OF NC
NC
01
—
Q592830280
MEDICARE
NC
Enumeration date
12/11/2017
Last updated
05/03/2018
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