Healthcare Provider Details

I. General information

NPI: 1154902971
Provider Name (Legal Business Name): MELANIE LORRAINE VICK LCSW-A, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BONNIE LN
SYLVA NC
28779-8511
US

IV. Provider business mailing address

220 5TH AVE E
HENDERSONVILLE NC
28792-4377
US

V. Phone/Fax

Practice location:
  • Phone: 828-631-3973
  • Fax: 828-631-9280
Mailing address:
  • Phone: 286-924-2898
  • Fax: 828-696-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-27586
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP016373
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: