Provider Demographics
NPI:1265735666
Name:MITCHELL, MELODY (LCSW)
Entity type:Individual
Prefix:MISS
First Name:MELODY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 S GREEN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3517
Mailing Address - Country:US
Mailing Address - Phone:828-437-3000
Mailing Address - Fax:
Practice Address - Street 1:617 S GREEN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3517
Practice Address - Country:US
Practice Address - Phone:828-437-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW90991041C0700X
NCC0087411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC008741OtherLICENSE