Provider Demographics
NPI:1659502011
Name:GRANGER, MELODY R (LPC)
Entity Type:Individual
Prefix:MISS
First Name:MELODY
Middle Name:R
Last Name:GRANGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 NEW CENTRE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1680
Mailing Address - Country:US
Mailing Address - Phone:910-313-3232
Mailing Address - Fax:
Practice Address - Street 1:5041 NEW CENTRE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1680
Practice Address - Country:US
Practice Address - Phone:910-313-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7409101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health