Provider Demographics
NPI:1669717831
Name:MATTINGLY, MELODY A (MA, LPC, NCC, LCAS)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:A
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:MA, LPC, NCC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-4376
Mailing Address - Country:US
Mailing Address - Phone:704-636-5522
Mailing Address - Fax:704-636-5533
Practice Address - Street 1:417 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2814
Practice Address - Country:US
Practice Address - Phone:704-636-5522
Practice Address - Fax:704-636-5533
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9583101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health