Provider Demographics
NPI:1992042105
Name:BROCK, MELISSA RHYNES (LPC LCAS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RHYNES
Last Name:BROCK
Suffix:
Gender:F
Credentials:LPC LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 GENERAL LEE AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4815
Mailing Address - Country:US
Mailing Address - Phone:910-364-5799
Mailing Address - Fax:
Practice Address - Street 1:1310 RAEFORD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5085
Practice Address - Country:US
Practice Address - Phone:910-364-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9392101YP2500X
NC3124101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)