Provider Demographics
NPI:1417462466
Name:WOMBLE, MELANIE (DPSYCH (PROF))
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:WOMBLE
Suffix:
Gender:F
Credentials:DPSYCH (PROF)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 RIVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-3543
Mailing Address - Country:US
Mailing Address - Phone:703-759-2034
Mailing Address - Fax:
Practice Address - Street 1:183 RIVER PARK DR
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-3543
Practice Address - Country:US
Practice Address - Phone:703-759-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic