Provider Demographics
NPI:1629061254
Name:TYNDALL, MELANIE EBORN (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:EBORN
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4923
Mailing Address - Country:US
Mailing Address - Phone:252-975-2027
Mailing Address - Fax:252-975-3483
Practice Address - Street 1:105 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4923
Practice Address - Country:US
Practice Address - Phone:252-975-2027
Practice Address - Fax:252-975-3483
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0043071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
015RFOtherBCBS GROUP
NC6005246Medicaid
284162OtherMHN
1327COtherBCBS
NC6002763Medicaid
305567OtherMHN GROUP
NC6005246Medicaid
2875831CMedicare ID - Type Unspecified