Provider Demographics
NPI:1073292645
Name:DEMELLO, PAUL ELLIOTT (LCMHC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ELLIOTT
Last Name:DEMELLO
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E MARKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1442
Mailing Address - Country:US
Mailing Address - Phone:201-919-1859
Mailing Address - Fax:
Practice Address - Street 1:3622 LYCKAN PKWY STE 5007
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2539
Practice Address - Country:US
Practice Address - Phone:919-884-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health