Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 4787 | NC |
N | 103TC0700X | Clinical Psychologist | 4787 | NC |
Y | 103G00000X | Clinical Psychologist | 4787 | NC |
Y | 103TC0700X | Clinical Psychologist | 4787 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 4787 | NC |
N | 103TF0200X | Forensic Psychologist | 4787 | NC |
N | 103TM1800X | Intellectual & Developmental Disabilities | 4787 | NC |
N | 103TR0400X | Rehabilitation Psychologist | 4787 | NC |
NPI | 1063890614 |
---|---|
Provider Name | Michelle Jones Cueva |
First Address | Durham, NC 27705-4827 |
Second Address | Chapel Hill, NC 27517-8923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2015 |
Last Update Date | 15/05/2015 |