Provider Demographics
NPI:1932283819
Name:BRINSON, MELISSA (LCMHC-S, LCAS, CSS)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:BRINSON
Suffix:
Gender:F
Credentials:LCMHC-S, LCAS, CSS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:F
Other - Last Name:BRINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC-S, LCAS, CSS
Mailing Address - Street 1:1123 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1308
Mailing Address - Country:US
Mailing Address - Phone:919-618-7217
Mailing Address - Fax:984-279-1400
Practice Address - Street 1:1123 MARSHALL ST STE B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1308
Practice Address - Country:US
Practice Address - Phone:919-618-7217
Practice Address - Fax:984-279-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3115-S101YP2500X
NC1332101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102775Medicaid