Provider Demographics
NPI:1922177187
Name:HAYWOOD, MELVIN THOMAS (MED LPC NCC)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:THOMAS
Last Name:HAYWOOD
Suffix:
Gender:M
Credentials:MED LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 TWIN EAGLES DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9023
Mailing Address - Country:US
Mailing Address - Phone:803-714-0842
Mailing Address - Fax:
Practice Address - Street 1:1073 US HIGHWAY 321 BYPASS SOUTH
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180
Practice Address - Country:US
Practice Address - Phone:803-635-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC862101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health