Individual
MS. MICHELLE DERAE NEWTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC, LCAS, CCS-I
Contact information
Practice address
XXXX XX XXX, CHARLOTTE, NC 28203-2821
(047) 615-3500
(980) 217-4758
Mailing address
7825 BALLANTYNE COMMONS PKWY STE 110, CHARLOTTE, NC 28277-3175
(704) 446-0391
(704) 348-4057
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
21364
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-21512
NC
101YP2500X
Professional Counselor
Primary
11982
NC
Other
Enumeration date
11/03/2015
Last updated
10/21/2020
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