Provider Demographics
NPI:1356644660
Name:MELLERSON, JOY D (LCSW)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:D
Last Name:MELLERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-3210
Mailing Address - Country:US
Mailing Address - Phone:910-585-0352
Mailing Address - Fax:
Practice Address - Street 1:206 6TH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-3210
Practice Address - Country:US
Practice Address - Phone:910-585-0352
Practice Address - Fax:910-944-0712
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0070851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007723Medicaid
NCQ36673AMedicare UPIN