Provider Demographics
NPI:1780443192
Name:MIRACLE, KARYN ANN (LCMHCA)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:ANN
Last Name:MIRACLE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-1060
Mailing Address - Country:US
Mailing Address - Phone:910-330-9719
Mailing Address - Fax:
Practice Address - Street 1:123 BRIDGEPORT DR
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-1060
Practice Address - Country:US
Practice Address - Phone:910-330-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health