Provider Demographics
NPI:1518087964
Name:ELAM, MELISSA A (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:ELAM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:ELAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:9 MOTT AVE
Mailing Address - Street 2:FAMILY & CHILDREN'S AGENCY 4TH FLOOR
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3330
Mailing Address - Country:US
Mailing Address - Phone:203-855-8765
Mailing Address - Fax:203-838-3325
Practice Address - Street 1:9 MOTT AVE
Practice Address - Street 2:FAMILY & CHILDREN'S AGENCY 4TH FLOOR
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3330
Practice Address - Country:US
Practice Address - Phone:203-855-8765
Practice Address - Fax:203-838-3325
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CT001578101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional