Provider Demographics
NPI:1477923399
Name:COWAN, MELISSA (MABC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:MABC, LPC
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:DOXEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 LEON SULLIVAN WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2402
Mailing Address - Country:US
Mailing Address - Phone:304-346-9689
Mailing Address - Fax:304-345-4601
Practice Address - Street 1:16 LEON SULLIVAN WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2402
Practice Address - Country:US
Practice Address - Phone:304-346-9689
Practice Address - Fax:304-345-4601
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional