Provider Demographics
NPI:1821893017
Name:MELANIN THERAPY AND WELLNESS PRACTICE
Entity type:Organization
Organization Name:MELANIN THERAPY AND WELLNESS PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-251-7217
Mailing Address - Street 1:224 TURNERSBURG HWY # 1052
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-2797
Mailing Address - Country:US
Mailing Address - Phone:704-251-7217
Mailing Address - Fax:
Practice Address - Street 1:606 TRILLIUM CT SW
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-7913
Practice Address - Country:US
Practice Address - Phone:704-251-7217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty