Provider Demographics
NPI:1376823369
Name:TREVATHAN, MELISSA ERIN (PHD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ERIN
Last Name:TREVATHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ERIN
Other - Last Name:TREVATHAN-MINNIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2200 E LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2021
Mailing Address - Country:US
Mailing Address - Phone:281-923-7308
Mailing Address - Fax:
Practice Address - Street 1:5209 YORK RD STE B12
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4245
Practice Address - Country:US
Practice Address - Phone:410-532-2476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling