Provider Demographics
NPI:1811594237
Name:MELENDEZ, EVA (MSED, QMHP-A)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:MSED, QMHP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709A W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4570
Mailing Address - Country:US
Mailing Address - Phone:434-326-4577
Mailing Address - Fax:703-649-3557
Practice Address - Street 1:709A W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4570
Practice Address - Country:US
Practice Address - Phone:434-326-4577
Practice Address - Fax:703-649-3557
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty