Provider Demographics
NPI:1427598655
Name:DUBARD, MELVIN JR (EDS, LPC)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:DUBARD
Suffix:JR
Gender:M
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-0784
Mailing Address - Country:US
Mailing Address - Phone:803-943-9434
Mailing Address - Fax:803-943-9454
Practice Address - Street 1:372 PINE ST E
Practice Address - Street 2:
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944-9618
Practice Address - Country:US
Practice Address - Phone:803-943-9434
Practice Address - Fax:803-943-9454
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5783101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional