Healthcare Provider Details

I. General information

NPI: 1043121148
Provider Name (Legal Business Name): MELANIE PENDER RICHICHI DBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5003 CENTERWAY DR
DURHAM NC
27705-5487
US

IV. Provider business mailing address

5003 CENTERWAY DR
DURHAM NC
27705-5487
US

V. Phone/Fax

Practice location:
  • Phone: 919-724-6846
  • Fax:
Mailing address:
  • Phone: 919-724-6846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: