Provider Demographics
NPI:1376993329
Name:KING, MELINDA KAY (LPCMH)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAY
Last Name:KING
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4799 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:DE
Mailing Address - Zip Code:19962-1498
Mailing Address - Country:US
Mailing Address - Phone:302-535-2620
Mailing Address - Fax:302-269-3958
Practice Address - Street 1:57 SAULSBURY RD STE D
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3472
Practice Address - Country:US
Practice Address - Phone:302-336-8019
Practice Address - Fax:302-269-3958
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000782101YP2500X
DEPC0000782101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor