Provider Demographics
NPI:1629548342
Name:ERWIN-PENNINGTON, MELANIE DAWN (MED, LPCA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:DAWN
Last Name:ERWIN-PENNINGTON
Suffix:
Gender:F
Credentials:MED, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0527
Mailing Address - Country:US
Mailing Address - Phone:606-216-8696
Mailing Address - Fax:
Practice Address - Street 1:181 ROY CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9407
Practice Address - Country:US
Practice Address - Phone:606-439-1316
Practice Address - Fax:606-436-2667
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172081101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health