Provider Demographics
NPI:1427699552
Name:CLENDANIEL, MELISSA M (MS, NCC, LACMH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:CLENDANIEL
Suffix:
Gender:F
Credentials:MS, NCC, LACMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-9639
Mailing Address - Country:US
Mailing Address - Phone:302-249-0754
Mailing Address - Fax:
Practice Address - Street 1:400 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-9639
Practice Address - Country:US
Practice Address - Phone:302-249-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AC-0000143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health