Healthcare Provider Details

I. General information

NPI: 1861389264
Provider Name (Legal Business Name): MELISSA NICOLE MARQUES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4723 NW 53RD AVE STE B
GAINESVILLE FL
32653-4804
US

IV. Provider business mailing address

3811 1ST AVE NW # NQ
NAPLES FL
34120-2713
US

V. Phone/Fax

Practice location:
  • Phone: 352-235-9006
  • Fax:
Mailing address:
  • Phone: 239-595-8736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH2594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: