Provider Demographics
NPI:1013160746
Name:BINGHAM, MELANIE CHRISTINE (MA)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:CHRISTINE
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 EVERGREEN PL
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-6593
Mailing Address - Country:US
Mailing Address - Phone:407-284-9383
Mailing Address - Fax:
Practice Address - Street 1:1103 EVERGREEN PL
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-6593
Practice Address - Country:US
Practice Address - Phone:407-284-9383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-26
Last Update Date:2021-10-26
Deactivation Date:2012-03-19
Deactivation Code:
Reactivation Date:2021-10-26
Provider Licenses
StateLicense IDTaxonomies
FLB525543758730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health