Provider Demographics
NPI:1477195998
Name:SOUTH, MELISSA D (LPC, NCC, ACS)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:D
Last Name:SOUTH
Suffix:
Gender:F
Credentials:LPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1025
Mailing Address - Country:US
Mailing Address - Phone:201-407-8870
Mailing Address - Fax:
Practice Address - Street 1:76 S ORANGE AVE STE 209
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1923
Practice Address - Country:US
Practice Address - Phone:201-740-7128
Practice Address - Fax:973-378-9575
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00450800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health