Provider Demographics
NPI:1558739763
Name:SMITH, MELODY H (MA, LMFT, CACI)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LMFT, CACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FAMILY CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3437
Mailing Address - Country:US
Mailing Address - Phone:843-300-8899
Mailing Address - Fax:
Practice Address - Street 1:39 BROAD ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-3019
Practice Address - Country:US
Practice Address - Phone:843-300-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1311269101YA0400X
SC4553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)