Provider Demographics
NPI:1902376692
Name:MELTON, CHRISTINIA NICOLE (LPCC)
Entity type:Individual
Prefix:
First Name:CHRISTINIA
Middle Name:NICOLE
Last Name:MELTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:CHRISTINIA
Other - Middle Name:NICOLE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC
Mailing Address - Street 1:436 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1553
Mailing Address - Country:US
Mailing Address - Phone:270-216-6216
Mailing Address - Fax:
Practice Address - Street 1:436 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1553
Practice Address - Country:US
Practice Address - Phone:270-216-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
KY297948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator