Provider Demographics
NPI:1952547259
Name:MELENBACKER, INGRID J (MEDHD, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:J
Last Name:MELENBACKER
Suffix:
Gender:F
Credentials:MEDHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 ZEKAN LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1014
Mailing Address - Country:US
Mailing Address - Phone:703-967-5070
Mailing Address - Fax:
Practice Address - Street 1:8440 OLD KEENE MILL ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2302
Practice Address - Country:US
Practice Address - Phone:703-569-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional