Provider Demographics
NPI:1992789960
Name:MELTON, BOYDEN DEAN (LCAS)
Entity type:Individual
Prefix:
First Name:BOYDEN
Middle Name:DEAN
Last Name:MELTON
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 1:417 N MAIN ST
Mailing Address - Street 2:CORPORATE SQUARE
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-4376
Mailing Address - Country:US
Mailing Address - Phone:336-416-0892
Mailing Address - Fax:
Practice Address - Street 1:417 N MAIN ST
Practice Address - Street 2:CORPORATE SQUARE
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4376
Practice Address - Country:US
Practice Address - Phone:336-416-0892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC166101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB2306OtherMEDCOST
NC6111821Medicaid