Provider Demographics
NPI:1457661787
Name:COGBURN, MELITA (BS, MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MELITA
Middle Name:
Last Name:COGBURN
Suffix:
Gender:F
Credentials:BS, MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 PEPPERDINE LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6646
Mailing Address - Country:US
Mailing Address - Phone:407-435-4711
Mailing Address - Fax:517-000-0000
Practice Address - Street 1:5749 WESTGATE DR STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5040
Practice Address - Country:US
Practice Address - Phone:407-340-8619
Practice Address - Fax:517-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health