Provider Demographics
NPI:1760350656
Name:MICHAEL, AVA HELENE (LCMHCA)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:HELENE
Last Name:MICHAEL
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 1:4910 RANDALL PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2827
Mailing Address - Country:US
Mailing Address - Phone:910-515-4556
Mailing Address - Fax:910-446-3668
Practice Address - Street 1:4910 RANDALL PKWY STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2827
Practice Address - Country:US
Practice Address - Phone:910-515-4556
Practice Address - Fax:910-446-3668
Is Sole Proprietor?:No
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA22190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA22190OtherLCMHCA