Provider Demographics
NPI:1063824951
Name:MELTON, KRISTA S (MSW,LCSW-A)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:S
Last Name:MELTON
Suffix:
Gender:F
Credentials:MSW,LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-7701
Mailing Address - Country:US
Mailing Address - Phone:910-574-0418
Mailing Address - Fax:
Practice Address - Street 1:2543 RAVENHILL DR STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5459
Practice Address - Country:US
Practice Address - Phone:910-339-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0110381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical