Provider Demographics
NPI:1992224133
Name:HANNAFORD, MELISSA L (LICDC/LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:HANNAFORD
Suffix:
Gender:F
Credentials:LICDC/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5267
Mailing Address - Country:US
Mailing Address - Phone:419-330-1050
Mailing Address - Fax:
Practice Address - Street 1:1090 W SOUTH BOUNDARY ST STE 600
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5249
Practice Address - Country:US
Practice Address - Phone:419-873-8320
Practice Address - Fax:419-330-5115
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1600414101YM0800X
OHLICDC.161545101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health