Provider Demographics
NPI:1346487568
Name:WATTS, MELANIE A (LPC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:WATTS
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 1:1108 WILBORN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-3132
Mailing Address - Country:US
Mailing Address - Phone:434-471-1432
Mailing Address - Fax:888-860-6336
Practice Address - Street 1:1108 WILBORN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3132
Practice Address - Country:US
Practice Address - Phone:434-471-1432
Practice Address - Fax:888-860-6336
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104100Medicaid