Healthcare Provider Details

I. General information

NPI: 1821010919
Provider Name (Legal Business Name): DANIELLE MARIE MELBOUCI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 EASTERDAY RD
MYERSVILLE MD
21773-8620
US

IV. Provider business mailing address

10409 EASTERDAY RD
MYERSVILLE MD
21773-8620
US

V. Phone/Fax

Practice location:
  • Phone: 240-367-9842
  • Fax: 720-452-0227
Mailing address:
  • Phone: 240-367-9842
  • Fax: 720-452-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2892
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC7408
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: