Provider Demographics
NPI:1205227121
Name:HENLINE, MELINDA KAY (MA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAY
Last Name:HENLINE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 LYNN BROOKE PL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25312-6412
Mailing Address - Country:US
Mailing Address - Phone:304-744-8183
Mailing Address - Fax:
Practice Address - Street 1:200 KANAWHA TER
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2867
Practice Address - Country:US
Practice Address - Phone:304-727-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1106103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical