Provider Demographics
NPI:1922304930
Name:O'NEILL, MELISSA CHRISTNE (MS,, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CHRISTNE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MS,, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S OLIVE ST STE 202A
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3228
Mailing Address - Country:US
Mailing Address - Phone:484-574-1041
Mailing Address - Fax:
Practice Address - Street 1:20 S OLIVE ST STE 202A
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3228
Practice Address - Country:US
Practice Address - Phone:484-574-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC005110OtherLICENSE NUMBER