Provider Demographics
NPI:1851639942
Name:SUMRALL, MELANIE W (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:W
Last Name:SUMRALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61354 QUEEN ANNE DR
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-2836
Mailing Address - Country:US
Mailing Address - Phone:985-882-6606
Mailing Address - Fax:
Practice Address - Street 1:130 ROBINHOOD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5754
Practice Address - Country:US
Practice Address - Phone:985-543-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical