Healthcare Provider Details

I. General information

NPI: 1487611968
Provider Name (Legal Business Name): MELISSA COLLINS HARRELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MALLOY ST UNIT E
GOLDSBORO NC
27534-4478
US

IV. Provider business mailing address

121 HOUNDS RUN DR
GOLDSBORO NC
27530-5538
US

V. Phone/Fax

Practice location:
  • Phone: 919-778-5594
  • Fax: 919-778-5633
Mailing address:
  • Phone: 919-778-5594
  • Fax: 919-778-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3887
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: