Provider Demographics
NPI:1538559588
Name:LONDRY, MELISSA SUE ANN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE ANN
Last Name:LONDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SUE ANN
Other - Last Name:PEDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1141
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-1141
Mailing Address - Country:US
Mailing Address - Phone:276-293-1235
Mailing Address - Fax:540-613-1831
Practice Address - Street 1:210 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-3806
Practice Address - Country:US
Practice Address - Phone:276-293-1235
Practice Address - Fax:540-613-1831
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1538559588Medicaid