Provider Demographics
NPI:1174859169
Name:MELTON, MELANIE ROSE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ROSE
Last Name:MELTON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 WAKE FOREST RD STE 349
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-0010
Mailing Address - Country:US
Mailing Address - Phone:919-627-1823
Mailing Address - Fax:
Practice Address - Street 1:1502 W, NC-54 STE 403
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-418-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2023-10-15
Deactivation Date:2022-08-31
Deactivation Code:
Reactivation Date:2022-11-04
Provider Licenses
StateLicense IDTaxonomies
NC1355106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist