Provider Demographics
NPI:1508423195
Name:YAEGER, MELISSA DIANE (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANE
Last Name:YAEGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 BELL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT EPHRAIM
Mailing Address - State:NJ
Mailing Address - Zip Code:08059-1714
Mailing Address - Country:US
Mailing Address - Phone:856-651-8869
Mailing Address - Fax:
Practice Address - Street 1:215 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:HADDON TWP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2634
Practice Address - Country:US
Practice Address - Phone:856-654-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC006020700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional