Provider Demographics
NPI:1952608317
Name:CORDERO, MELBA EUNICE (MS, LCMHC-S)
Entity Type:Individual
Prefix:
First Name:MELBA
Middle Name:EUNICE
Last Name:CORDERO
Suffix:
Gender:F
Credentials:MS, LCMHC-S
Other - Prefix:
Other - First Name:MELBA
Other - Middle Name:EUNICE
Other - Last Name:FINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:PO BOX 1704
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28026-1704
Mailing Address - Country:US
Mailing Address - Phone:704-490-6667
Mailing Address - Fax:980-223-5001
Practice Address - Street 1:1 BUFFALO AVE NW STE 213
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4005
Practice Address - Country:US
Practice Address - Phone:980-781-0251
Practice Address - Fax:980-223-5001
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS8327101YM0800X, 101YP2500X
NC8327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC275095761Medicaid