Provider Demographics
NPI:1366954687
Name:DRAGO, MICHELLE JENNIFER
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JENNIFER
Last Name:DRAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 PRINCESS ST STE 203
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3964
Mailing Address - Country:US
Mailing Address - Phone:910-877-1598
Mailing Address - Fax:910-466-7998
Practice Address - Street 1:244 PRINCESS ST STE 203
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3964
Practice Address - Country:US
Practice Address - Phone:910-202-5709
Practice Address - Fax:910-202-9966
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0120761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical