Provider Demographics
NPI:1134632177
Name:VANCE, MELISSA DAWN (AAS, BA, LCDCIII)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:DAWN
Last Name:VANCE
Suffix:
Gender:F
Credentials:AAS, BA, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 COLUMBUS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1331
Mailing Address - Country:US
Mailing Address - Phone:740-594-2276
Mailing Address - Fax:
Practice Address - Street 1:86 COLUMBUS RD STE 103
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1331
Practice Address - Country:US
Practice Address - Phone:740-594-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161507101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)