Healthcare Provider Details

I. General information

NPI: 1184995813
Provider Name (Legal Business Name): MELANGE HEALTH SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 N HIGHLAND ST
GASTONIA NC
28052-2108
US

IV. Provider business mailing address

PO BOX 29234
CHARLOTTE NC
28229-9234
US

V. Phone/Fax

Practice location:
  • Phone: 704-567-8690
  • Fax:
Mailing address:
  • Phone: 704-567-8690
  • Fax: 704-536-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK BROWN
Title or Position: PRINCIPAL
Credential:
Phone: 704-567-8690