The topic of Mississippian origins in the North Carolina Piedmont has received very little attention from archaeologists since the 1950s. This chapter pulls together information from multiple sites, especially the extensively excavated Town Creek site, to present an overview of Early Mississippian in the North Carolina Piedmont. The presence of Mississippian lifeways in the region is indicated by the appearance of complicated-stamped ceramics by around A.D. 1150-1200. Associated social changes include the appearance of archaeologically visible households and the development of a civic-ceremonial center at the Town Creek site. Public and domestic architecture as well as evidence for ritual activities suggests that social groups interacted and were integrated at multiple scales within the Early Mississippian community at Town Creek.