Provider Demographics
NPI:1548792112
Name:MELISHA OTERO,LLC
Entity Type:Organization
Organization Name:MELISHA OTERO,LLC
Other - Org Name:MELISHA COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-536-0780
Mailing Address - Street 1:7400 BEAUFONT SPRINGS DR
Mailing Address - Street 2:SUITE 300, #905
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5556
Mailing Address - Country:US
Mailing Address - Phone:804-536-0780
Mailing Address - Fax:
Practice Address - Street 1:7400 BEAUFONT SPRINGS DR
Practice Address - Street 2:SUITE 300, #905
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-5556
Practice Address - Country:US
Practice Address - Phone:804-536-0780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty