Provider Demographics
NPI:1982372751
Name:HENDERSON, MELISSA ROBIN (PMHNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROBIN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 TOWNSEND RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-6981
Mailing Address - Country:US
Mailing Address - Phone:910-225-2291
Mailing Address - Fax:
Practice Address - Street 1:2003 GODWIN AVE STE C
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3150
Practice Address - Country:US
Practice Address - Phone:910-674-4814
Practice Address - Fax:910-674-4842
Is Sole Proprietor?:No
Enumeration Date:2021-09-05
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015346363LP0808X
NC232021163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health