Provider Demographics
NPI:1669650453
Name:MELISTAS, KALIOPI EVANGELIA (MS, LLP)
Entity Type:Individual
Prefix:
First Name:KALIOPI
Middle Name:EVANGELIA
Last Name:MELISTAS
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 AUTO CLUB DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2749
Mailing Address - Country:US
Mailing Address - Phone:313-317-2041
Mailing Address - Fax:
Practice Address - Street 1:5111 AUTO CLUB DR
Practice Address - Street 2:SUITE 112
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2749
Practice Address - Country:US
Practice Address - Phone:313-317-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical