Provider Demographics
NPI:1730409293
Name:GROSS, MICHELLE PATTERSON (LPC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:PATTERSON
Last Name:GROSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 HUNTINGDON RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1646
Mailing Address - Country:US
Mailing Address - Phone:336-760-1379
Mailing Address - Fax:
Practice Address - Street 1:1131 HUNTINGDON RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-1646
Practice Address - Country:US
Practice Address - Phone:336-760-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional