Healthcare Provider Details

I. General information

NPI: 1255004438
Provider Name (Legal Business Name): MELVINA THOMPSON BSL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W MAIN ST
FLEETWOOD PA
19522-1350
US

IV. Provider business mailing address

1 W MAIN ST
FLEETWOOD PA
19522-1350
US

V. Phone/Fax

Practice location:
  • Phone: 610-944-0445
  • Fax: 610-944-1196
Mailing address:
  • Phone: 610-944-0445
  • Fax: 610-944-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBH008556
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: