Provider Demographics
NPI:1538227863
Name:MELL, TAMRA LAMBETH (LPA)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:LAMBETH
Last Name:MELL
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 W FRIENDLY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5642
Mailing Address - Country:US
Mailing Address - Phone:336-549-5732
Mailing Address - Fax:336-625-6113
Practice Address - Street 1:505 SOUTH CHURCH STREET
Practice Address - Street 2:RANDOLPH COUNSELING CENTER
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203
Practice Address - Country:US
Practice Address - Phone:336-549-5732
Practice Address - Fax:336-625-6113
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1352103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107332Medicaid