Healthcare Provider Details

I. General information

NPI: 1477820249
Provider Name (Legal Business Name): CHRISTINA MELVILLE NCC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 BOND ST STE 119
NAPERVILLE IL
60563-2368
US

IV. Provider business mailing address

1323 BOND ST STE 119
NAPERVILLE IL
60563-2368
US

V. Phone/Fax

Practice location:
  • Phone: 630-717-9408
  • Fax: 630-596-8496
Mailing address:
  • Phone: 630-717-9408
  • Fax: 630-596-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.006994
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180008607
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: