Provider Demographics
NPI:1003944166
Name:MELVIN, MARCELLINA (MA)
Entity Type:Individual
Prefix:
First Name:MARCELLINA
Middle Name:
Last Name:MELVIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 S TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-4201
Mailing Address - Country:US
Mailing Address - Phone:615-847-9218
Mailing Address - Fax:
Practice Address - Street 1:915 8TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2621
Practice Address - Country:US
Practice Address - Phone:615-460-3975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health