Provider Demographics
NPI:1831107739
Name:MELANY COOPMANS VIZITHUM LCSW PC
Entity Type:Organization
Organization Name:MELANY COOPMANS VIZITHUM LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:COOPMANS VIZITHUM
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCSW
Authorized Official - Phone:919-636-0984
Mailing Address - Street 1:200 W WEAVER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-6009
Mailing Address - Country:US
Mailing Address - Phone:919-636-0984
Mailing Address - Fax:919-968-0403
Practice Address - Street 1:200 W WEAVER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-6009
Practice Address - Country:US
Practice Address - Phone:919-636-0984
Practice Address - Fax:919-968-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0040911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty