Provider Demographics
NPI:1447348875
Name:POPPE-ROCKWELL, MICHELLE RUTTER (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RUTTER
Last Name:POPPE-ROCKWELL
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W. MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-872-1190
Mailing Address - Fax:919-790-2361
Practice Address - Street 1:230 W. MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-872-1190
Practice Address - Fax:919-790-2361
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102608Medicaid