Provider Demographics
NPI:1962658427
Name:MACDONALD, MELISSA A (LPC, LCADC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BRICK BLVD
Mailing Address - Street 2:BLDG 4, SUITE 206B
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-477-0862
Mailing Address - Fax:732-477-0879
Practice Address - Street 1:74 BRICK BLVD
Practice Address - Street 2:BLDG 4, SUITE 206B
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:732-477-0862
Practice Address - Fax:732-477-0879
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00376700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC00191000OtherLCADC
NJ37PC00376700OtherLPC