Provider Demographics
NPI:1083329932
Name:NICHOLAS, MELODY (MA, LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MA, LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 CENTERVIEW DR
Mailing Address - Street 2:STE 204 #586505
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-8012
Mailing Address - Country:US
Mailing Address - Phone:336-422-0768
Mailing Address - Fax:
Practice Address - Street 1:5540 CENTERVIEW DR
Practice Address - Street 2:STE 204 #586505
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-8012
Practice Address - Country:US
Practice Address - Phone:336-422-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1700892478OtherNATIONAL PROVIDER IDENTIFIER (NPI)