Provider Demographics
NPI:1770653438
Name:CLONTZ, MELINDA H (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:H
Last Name:CLONTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:HOILMAN
Other - Last Name:CLONTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:117 N POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3315
Mailing Address - Country:US
Mailing Address - Phone:704-754-4726
Mailing Address - Fax:704-754-4726
Practice Address - Street 1:117 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3315
Practice Address - Country:US
Practice Address - Phone:704-754-4726
Practice Address - Fax:704-754-4726
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054111041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003103Medicaid
NC6003103Medicaid