Provider Demographics
NPI:1679915045
Name:STANCIL, MELISSA L (MA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:STANCIL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DENIM DR
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-2204
Mailing Address - Country:US
Mailing Address - Phone:910-897-8930
Mailing Address - Fax:910-897-8932
Practice Address - Street 1:400 DENIM DR
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-2204
Practice Address - Country:US
Practice Address - Phone:910-897-8930
Practice Address - Fax:910-897-8932
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10638101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional