Provider Demographics
NPI:1225208978
Name:PICKETT, MARTHA MELLETTE (CCS)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:MELLETTE
Last Name:PICKETT
Suffix:
Gender:F
Credentials:CCS
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:MELLETTE
Other - Last Name:PICKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS
Mailing Address - Street 1:104 NEW STATESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-1165
Mailing Address - Country:US
Mailing Address - Phone:919-942-2803
Mailing Address - Fax:919-942-2126
Practice Address - Street 1:355 C1 MADISON BLVD.
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5485
Practice Address - Country:US
Practice Address - Phone:336-599-8366
Practice Address - Fax:336-322-6168
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC406101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)