Provider Demographics
NPI:1699148361
Name:NEWTON, MICHELLE DERAE (LCMHC, LCAS, CCS-I)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DERAE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:LCMHC, LCAS, CCS-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 BALLANTYNE COMMONS PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3175
Mailing Address - Country:US
Mailing Address - Phone:704-446-0391
Mailing Address - Fax:704-348-4057
Practice Address - Street 1:XXXX XX XXX
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-2821
Practice Address - Country:US
Practice Address - Phone:047-615-3500
Practice Address - Fax:980-217-4758
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21512101YA0400X
NC21364101YA0400X
NC11982101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)