Provider Demographics
NPI:1457475816
Name:PHILLIPS, MELISSA MENDITCH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MENDITCH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD,
Mailing Address - Street 1:15817 CRABBS BRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-6613
Mailing Address - Country:US
Mailing Address - Phone:626-354-2748
Mailing Address - Fax:
Practice Address - Street 1:15817 CRABBS BRANCH WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-6613
Practice Address - Country:US
Practice Address - Phone:626-354-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health