Healthcare Provider Details

I. General information

NPI: 1043852924
Provider Name (Legal Business Name): MELANIE CRAIN BLACKWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 BOONE STATION DR STE 101
BURLINGTON NC
27215-6082
US

IV. Provider business mailing address

PO BOX 360595
PITTSBURGH PA
15251-6595
US

V. Phone/Fax

Practice location:
  • Phone: 718-215-5311
  • Fax: 718-865-5165
Mailing address:
  • Phone: 718-215-5311
  • Fax: 718-865-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-48577
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: