Provider Demographics
NPI:1093838682
Name:MENDLESON, DENNIS G (LPCS, ACH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:G
Last Name:MENDLESON
Suffix:
Gender:M
Credentials:LPCS, ACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 STRAWFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3779
Mailing Address - Country:US
Mailing Address - Phone:513-885-6365
Mailing Address - Fax:
Practice Address - Street 1:6316 STRAWFIELD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3779
Practice Address - Country:US
Practice Address - Phone:513-885-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8352101YM0800X
OHE 0002213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104768Medicaid