Provider Demographics
NPI:1598876757
Name:ELLIOTT, MELISSA L (M ED LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:L
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:M ED LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 VIGO CT
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9340
Mailing Address - Country:US
Mailing Address - Phone:919-761-9446
Mailing Address - Fax:919-761-9446
Practice Address - Street 1:149 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-8601
Practice Address - Country:US
Practice Address - Phone:919-306-4815
Practice Address - Fax:919-761-9446
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC675101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13846OtherNC HEALTH CHOICE
NC6105048Medicaid
NC8376OtherFIVE COUNTY MENTAL HEALTH