Provider Demographics
NPI:1790842409
Name:MCDANIEL, MELISSA LEIGH (M ED, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEIGH
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:M ED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1001 ASHELY GLEN LN
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-6524
Mailing Address - Country:US
Mailing Address - Phone:704-825-0541
Mailing Address - Fax:704-825-0542
Practice Address - Street 1:7202 W WILKINSON BLVD STE E
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-6224
Practice Address - Country:US
Practice Address - Phone:704-825-0541
Practice Address - Fax:704-825-0542
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC4521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005433Medicaid
NC6102508Medicaid