Provider Demographics
NPI:1851654255
Name:MELLO, MARIE DIANE (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:DIANE
Last Name:MELLO
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2702
Mailing Address - Country:US
Mailing Address - Phone:251-928-9870
Mailing Address - Fax:
Practice Address - Street 1:111 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2702
Practice Address - Country:US
Practice Address - Phone:251-928-9870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional