Healthcare Provider Details

I. General information

NPI: 1538227863
Provider Name (Legal Business Name): TAMRA LAMBETH MELL LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SOUTH CHURCH STREET RANDOLPH COUNSELING CENTER
ASHEBORO NC
27203
US

IV. Provider business mailing address

3812 W FRIENDLY AVE
GREENSBORO NC
27410-5642
US

V. Phone/Fax

Practice location:
  • Phone: 336-549-5732
  • Fax: 336-625-6113
Mailing address:
  • Phone: 336-549-5732
  • Fax: 336-625-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1352
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: