Provider Demographics
NPI:1740544790
Name:CHILDERS, MELANIE DAWN (LCMHCS)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:DAWN
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2600
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-2600
Mailing Address - Country:US
Mailing Address - Phone:828-266-1178
Mailing Address - Fax:828-266-2484
Practice Address - Street 1:336 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5008
Practice Address - Country:US
Practice Address - Phone:828-266-1178
Practice Address - Fax:828-266-2484
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8830101Y00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor