Provider Demographics
NPI:1114786548
Name:BROWN, MELISSA LEE (PEER SUPPORTER)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PEER SUPPORTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7058 CORPORATE WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4243
Mailing Address - Country:US
Mailing Address - Phone:937-991-0080
Mailing Address - Fax:937-991-0080
Practice Address - Street 1:7058 CORPORATE WAY STE 3
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4243
Practice Address - Country:US
Practice Address - Phone:937-991-0080
Practice Address - Fax:937-991-3083
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty