Provider Demographics
NPI:1265817217
Name:ROSADO, MELINDA (LPC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:ROSADO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 ISLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7991
Mailing Address - Country:US
Mailing Address - Phone:843-697-3562
Mailing Address - Fax:877-780-1103
Practice Address - Street 1:895 ISLAND PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7991
Practice Address - Country:US
Practice Address - Phone:843-697-3562
Practice Address - Fax:877-780-1103
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2491101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional