Provider Demographics
NPI:1821264383
Name:BARTLES, MARY MELISSA (CACAD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MELISSA
Last Name:BARTLES
Suffix:
Gender:F
Credentials:CACAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 COLSTON DR
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-7055
Mailing Address - Country:US
Mailing Address - Phone:304-274-0097
Mailing Address - Fax:240-313-3371
Practice Address - Street 1:13114 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2741
Practice Address - Country:US
Practice Address - Phone:240-313-3398
Practice Address - Fax:240-313-3371
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD010733101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)