Provider Demographics
NPI:1093238792
Name:MELLION, LATEADRA
Entity Type:Individual
Prefix:
First Name:LATEADRA
Middle Name:
Last Name:MELLION
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 1:3888 S SHERWOOD FOREST BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4400
Mailing Address - Country:US
Mailing Address - Phone:225-771-8251
Mailing Address - Fax:225-771-8253
Practice Address - Street 1:3888 SOUTH SHERWOOD FOREST BLVD
Practice Address - Street 2:BLDG II STE F
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816
Practice Address - Country:US
Practice Address - Phone:225-771-8251
Practice Address - Fax:225-771-8253
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor