Provider Demographics
NPI:1104366350
Name:MELKON, ALINE GISELLE
Entity Type:Individual
Prefix:
First Name:ALINE
Middle Name:GISELLE
Last Name:MELKON
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 1:7559 WILLOUGHBY AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-7446
Mailing Address - Country:US
Mailing Address - Phone:213-840-6212
Mailing Address - Fax:
Practice Address - Street 1:7559 WILLOUGHBY AVE APT 5
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-7446
Practice Address - Country:US
Practice Address - Phone:213-840-6212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)