Provider Demographics
NPI:1679007645
Name:MELVIN, CHANDA UNIQUE (PHD)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:UNIQUE
Last Name:MELVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:UNIQUE
Other - Middle Name:
Other - Last Name:MELVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1400 N JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1650
Mailing Address - Country:US
Mailing Address - Phone:619-440-4801
Mailing Address - Fax:
Practice Address - Street 1:1400 N JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1650
Practice Address - Country:US
Practice Address - Phone:619-440-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health