Provider Demographics
NPI:1235383282
Name:FABENY, MELISSA MARIE MOSCA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MARIE MOSCA
Last Name:FABENY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 GREENWOOD CLFS
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2821
Mailing Address - Country:US
Mailing Address - Phone:704-334-0524
Mailing Address - Fax:704-334-0524
Practice Address - Street 1:1116 GREENWOOD CLFS
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2821
Practice Address - Country:US
Practice Address - Phone:704-334-0524
Practice Address - Fax:704-334-0524
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104035Medicaid