Provider Demographics
NPI:1457658882
Name:MCCOY, MELANIE (PHD, LICSW, LCSWC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PHD, LICSW, LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 MARTHAS CHOICE CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4702
Mailing Address - Country:US
Mailing Address - Phone:301-906-8210
Mailing Address - Fax:
Practice Address - Street 1:317 E DIAMOND AVE STE C
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-5327
Practice Address - Country:US
Practice Address - Phone:301-906-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113621041C0700X
DCLC30008671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical