Provider Demographics
NPI:1831833516
Name:FARRELL, MELINDA ANNETTE (ADT)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:ANNETTE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:ADT
Other - Prefix:MISS
Other - First Name:MELINDA
Other - Middle Name:ANNETTE
Other - Last Name:HAUCK-PALUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38448 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-6313
Mailing Address - Country:US
Mailing Address - Phone:443-968-1016
Mailing Address - Fax:
Practice Address - Street 1:30007 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3101
Practice Address - Country:US
Practice Address - Phone:301-997-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT2670101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)