Provider Demographics
NPI:1295537785
Name:MELGOZA-COLIN, LESLY GUADALUPE
Entity type:Individual
Prefix:
First Name:LESLY
Middle Name:GUADALUPE
Last Name:MELGOZA-COLIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 JONES ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-3613
Mailing Address - Country:US
Mailing Address - Phone:704-406-7041
Mailing Address - Fax:704-406-7041
Practice Address - Street 1:302 JONES ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3613
Practice Address - Country:US
Practice Address - Phone:704-406-7041
Practice Address - Fax:704-406-7041
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-24-356532106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician