Healthcare Provider Details

I. General information

NPI: 1285382549
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL MELVIN CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PAGE DR
PINEHURST NC
28374-8847
US

IV. Provider business mailing address

20 PAGE DR
PINEHURST NC
28374-8847
US

V. Phone/Fax

Practice location:
  • Phone: 910-719-2497
  • Fax:
Mailing address:
  • Phone: 910-719-2497
  • Fax: 910-235-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC-2566
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: