Provider Demographics
NPI:1376669358
Name:HOLDER, MELISSA FAITH (BA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:FAITH
Last Name:HOLDER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 OLD YORK RD
Mailing Address - Street 2:1-A
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2028
Mailing Address - Country:US
Mailing Address - Phone:215-568-0860
Mailing Address - Fax:215-825-3701
Practice Address - Street 1:112 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1510
Practice Address - Country:US
Practice Address - Phone:215-568-0860
Practice Address - Fax:215-568-0769
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor