Healthcare Provider Details

I. General information

NPI: 1013261437
Provider Name (Legal Business Name): MELISA D. ANDREWS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 KETTERING BLVD.
DAYTON OH
45439
US

IV. Provider business mailing address

3095 KETTERING BLVD.
DAYTON OH
45439
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1200295
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1200295
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: