Provider Demographics
NPI:1891825436
Name:BOSCO, MELANIE A (MA, LPA, LPC, LCMHC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:BOSCO
Suffix:
Gender:F
Credentials:MA, LPA, LPC, LCMHC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,LPA
Mailing Address - Street 1:3601 MILSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7672
Mailing Address - Country:US
Mailing Address - Phone:704-281-5801
Mailing Address - Fax:
Practice Address - Street 1:3601 MILSHIRE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7672
Practice Address - Country:US
Practice Address - Phone:704-281-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2302103TC0700X
VA0701006860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017441080001Medicaid
NC6107248Medicaid