Provider Demographics
NPI:1104892827
Name:MEYERS, MELISSA REGISTER (MED, LPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:REGISTER
Last Name:MEYERS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4744 US 421 S
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-6727
Mailing Address - Country:US
Mailing Address - Phone:910-916-6404
Mailing Address - Fax:919-557-8223
Practice Address - Street 1:320 N JUDD PKWY NE
Practice Address - Street 2:SUITE 200
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2624
Practice Address - Country:US
Practice Address - Phone:919-557-8222
Practice Address - Fax:919-557-8223
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200173438OtherTAX ID
NC6102632Medicaid