Provider Demographics
NPI:1518472042
Name:CHILDERS, MELANIE BROOKE (LPC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:BROOKE
Last Name:CHILDERS
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 1:420 28TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1089
Mailing Address - Country:US
Mailing Address - Phone:205-737-3720
Mailing Address - Fax:
Practice Address - Street 1:420 28TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1089
Practice Address - Country:US
Practice Address - Phone:205-737-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty