Provider Demographics
NPI:1649373457
Name:MELTON, MARY HARRINGTON (MSW, LCSW, LCAS, CSI)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HARRINGTON
Last Name:MELTON
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS, CSI
Other - Prefix:
Other - First Name:'MEG'
Other - Middle Name:HARRINGTON
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW, LCAS, CSI
Mailing Address - Street 1:1319 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-6723
Mailing Address - Country:US
Mailing Address - Phone:704-242-3128
Mailing Address - Fax:
Practice Address - Street 1:400 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4804
Practice Address - Country:US
Practice Address - Phone:704-290-1540
Practice Address - Fax:704-624-9302
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC996101YA0400X
NCC0053301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106579Medicaid
NC6106579Medicaid