Healthcare Provider Details

I. General information

NPI: 1558102475
Provider Name (Legal Business Name): MELISSA A COLVIN CDCA/PRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4977 NORTHCUTT PL
DAYTON OH
45414-3839
US

IV. Provider business mailing address

5460 DOVETREE BLVD APT 20
MORAINE OH
45439-5117
US

V. Phone/Fax

Practice location:
  • Phone: 800-829-5461
  • Fax:
Mailing address:
  • Phone: 937-450-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.195854
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS005086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: