Provider Demographics
NPI:1821010919
Name:MELBOUCI, DANIELLE MARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARIE
Last Name:MELBOUCI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 EASTERDAY RD
Mailing Address - Street 2:
Mailing Address - City:MYERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21773-8620
Mailing Address - Country:US
Mailing Address - Phone:240-367-9842
Mailing Address - Fax:720-452-0227
Practice Address - Street 1:10409 EASTERDAY RD
Practice Address - Street 2:
Practice Address - City:MYERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21773-8620
Practice Address - Country:US
Practice Address - Phone:240-367-9842
Practice Address - Fax:720-452-0227
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2892101YM0800X
MDLC7408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11365234OtherCAQH
MD907076100Medicaid