Provider Demographics
NPI:1639691595
Name:CARMONA, MELISSA CATHERINE (LPCA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CATHERINE
Last Name:CARMONA
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 DELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3509
Mailing Address - Country:US
Mailing Address - Phone:828-238-0752
Mailing Address - Fax:
Practice Address - Street 1:1175 REVOLUTION MILL DR # 29-3
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5079
Practice Address - Country:US
Practice Address - Phone:828-238-0752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health