Provider Demographics
NPI:1346505922
Name:COYLE, MELLISSA LYNN (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:MELLISSA
Middle Name:LYNN
Last Name:COYLE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-7000
Mailing Address - Country:US
Mailing Address - Phone:252-399-6587
Mailing Address - Fax:
Practice Address - Street 1:704 COLLEGE ST NE
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3104
Practice Address - Country:US
Practice Address - Phone:252-399-6587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9836101YM0800X
OH1100587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health