Provider Demographics
NPI:1578695797
Name:DECKER, MELISSA MCGLOHON (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MCGLOHON
Last Name:DECKER
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 BUCKHORN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3219
Mailing Address - Country:US
Mailing Address - Phone:336-856-0507
Mailing Address - Fax:
Practice Address - Street 1:301 E WASHINGTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2957
Practice Address - Country:US
Practice Address - Phone:336-333-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102291Medicaid