Provider Demographics
NPI:1518312610
Name:MELTON, FELICIA (LLBSW)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18427 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2029
Mailing Address - Country:US
Mailing Address - Phone:313-704-1387
Mailing Address - Fax:
Practice Address - Street 1:18427 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2029
Practice Address - Country:US
Practice Address - Phone:313-704-1387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802-088939251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health