Provider Demographics
NPI:1891358453
Name:MOORE, MELINDA (CDCA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 SAWMILL RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1623
Mailing Address - Country:US
Mailing Address - Phone:614-389-3030
Mailing Address - Fax:
Practice Address - Street 1:5945 SAWMILL RD UNIT B
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1623
Practice Address - Country:US
Practice Address - Phone:614-389-3030
Practice Address - Fax:614-413-3536
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)