Provider Demographics
NPI:1578901732
Name:HOWELL, MELISSA ANN
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:HOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PORKY DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-8880
Mailing Address - Country:US
Mailing Address - Phone:910-739-0100
Mailing Address - Fax:
Practice Address - Street 1:6688 NC HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2501
Practice Address - Country:US
Practice Address - Phone:910-618-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP008154251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006953Medicaid