Provider Demographics
NPI:1457126054
Name:MORGAN, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-0901
Mailing Address - Country:US
Mailing Address - Phone:304-864-6666
Mailing Address - Fax:
Practice Address - Street 1:236 DILLONS CREEK RD
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:WV
Practice Address - Zip Code:26542
Practice Address - Country:US
Practice Address - Phone:304-864-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10-300S101YA0400X
WV2028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)