Provider Demographics
NPI:1174829865
Name:MCMINN, MELISSA (MS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MCMINN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 OLD MARS HILL HWY
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8602
Mailing Address - Country:US
Mailing Address - Phone:828-645-3687
Mailing Address - Fax:284-848-4638
Practice Address - Street 1:901 OLD MARS HILL HWY
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787
Practice Address - Country:US
Practice Address - Phone:828-645-3687
Practice Address - Fax:284-848-4638
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24097101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid