Provider Demographics
NPI:1427252907
Name:BANDY, MELANESE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:MELANESE
Middle Name:
Last Name:BANDY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550178
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28055-0178
Mailing Address - Country:US
Mailing Address - Phone:704-867-4411
Mailing Address - Fax:704-861-2235
Practice Address - Street 1:2505 COURT DR
Practice Address - Street 2:2ND FL
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:704-867-4411
Practice Address - Fax:704-861-2235
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCLPC#5545OtherM. BRANDY