Provider Demographics
NPI:1801912282
Name:CARRICO, MELISA MARCELLE (LCPC)
Entity type:Individual
Prefix:MS
First Name:MELISA
Middle Name:MARCELLE
Last Name:CARRICO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:M
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:1138 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-6825
Mailing Address - Country:US
Mailing Address - Phone:240-321-2487
Mailing Address - Fax:301-334-1577
Practice Address - Street 1:315 DAWSON AVE STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-5113
Practice Address - Country:US
Practice Address - Phone:240-321-2487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012466400Medicaid