Provider Demographics
NPI:1821387226
Name:GREEN, MELANI (LPC)
Entity Type:Individual
Prefix:
First Name:MELANI
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2084 EDDIE MASSEY LN
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-0025
Mailing Address - Country:US
Mailing Address - Phone:803-554-8638
Mailing Address - Fax:803-693-0829
Practice Address - Street 1:139 PINEHURST AVE STE A
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7099
Practice Address - Country:US
Practice Address - Phone:910-725-1246
Practice Address - Fax:803-693-0829
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5613101YP2500X
NC8121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1333Medicaid