Provider Demographics
NPI:1962699033
Name:ELLERBE, MELTON STONEWALL (LCAS)
Entity type:Individual
Prefix:
First Name:MELTON
Middle Name:STONEWALL
Last Name:ELLERBE
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 FULLERS WAY
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-4155
Mailing Address - Country:US
Mailing Address - Phone:910-331-2685
Mailing Address - Fax:803-693-0829
Practice Address - Street 1:139 PINEHURST AVE STE A
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7099
Practice Address - Country:US
Practice Address - Phone:910-725-1246
Practice Address - Fax:803-693-0829
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)