Provider Demographics
NPI:1376717223
Name:MELTON, LORI CHAMPION (LPC, CRC, CPHT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:CHAMPION
Last Name:MELTON
Suffix:
Gender:F
Credentials:LPC, CRC, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BANK ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-5203
Mailing Address - Country:US
Mailing Address - Phone:252-944-5098
Mailing Address - Fax:252-946-9552
Practice Address - Street 1:500 BANK ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-5203
Practice Address - Country:US
Practice Address - Phone:252-944-5098
Practice Address - Fax:252-946-9552
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional