Provider Demographics
NPI:1457482994
Name:FISH, MELANIE HARRIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:HARRIS
Last Name:FISH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LYNNE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:193 WADING BIRD LOOP
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-5909
Mailing Address - Country:US
Mailing Address - Phone:704-490-5752
Mailing Address - Fax:
Practice Address - Street 1:115 ATRIUM WAY STE 221
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6383
Practice Address - Country:US
Practice Address - Phone:843-501-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002913103TC1900X
SCPSY.1685103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling