Provider Demographics
NPI:1497326847
Name:FREDERICK, MELINDA F (MSW, CADCR, LCSWA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:F
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MSW, CADCR, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8870 DURANT NIXON RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28356-9371
Mailing Address - Country:US
Mailing Address - Phone:732-570-6698
Mailing Address - Fax:
Practice Address - Street 1:111 LAMON ST STE 100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4917
Practice Address - Country:US
Practice Address - Phone:910-483-0324
Practice Address - Fax:910-483-2246
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-26833101YA0400X
NCP0172651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)