Provider Demographics
NPI:1154654234
Name:STRAW, MICHAEL E (LCPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:STRAW
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4671 GARRISON INN CT NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8063
Mailing Address - Country:US
Mailing Address - Phone:781-962-0042
Mailing Address - Fax:
Practice Address - Street 1:4671 GARRISON INN CT NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8063
Practice Address - Country:US
Practice Address - Phone:781-962-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200620570AMedicaid