Provider Demographics
NPI:1801319991
Name:AVERY, MECHELE ROZIER (LCSWA, LCASA)
Entity type:Individual
Prefix:MRS
First Name:MECHELE
Middle Name:ROZIER
Last Name:AVERY
Suffix:
Gender:F
Credentials:LCSWA, LCASA
Other - Prefix:MISS
Other - First Name:MECHELE
Other - Middle Name:CAMILLA
Other - Last Name:ROZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 MOOREA DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7978
Mailing Address - Country:US
Mailing Address - Phone:910-603-4154
Mailing Address - Fax:
Practice Address - Street 1:400 MOOREA DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7978
Practice Address - Country:US
Practice Address - Phone:910-603-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NCP0117061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)