Individual
MS. KIM RAE MIKKELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
115 MARKET ST, SUITE 201, DURHAM, NC 27701-3251
(919) 560-5600
(919) 560-3018
Mailing address
708 VALLEY DR, DURHAM, NC 27704-1477
(919) 477-3642
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
C003728
NC
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139CP
BLUE CROSS
NC
Enumeration date
03/14/2007
Last updated
09/11/2025
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