Provider Demographics
NPI:1558974824
Name:VARNER, MELODY DOMINIQUE (PHD, LPCC)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:DOMINIQUE
Last Name:VARNER
Suffix:
Gender:F
Credentials:PHD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24660 GOLDSTON CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-4092
Mailing Address - Country:US
Mailing Address - Phone:951-533-1557
Mailing Address - Fax:
Practice Address - Street 1:24660 GOLDSTON CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-4092
Practice Address - Country:US
Practice Address - Phone:951-533-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008696101Y00000X
CALPCC7793101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty