Healthcare Provider Details

I. General information

NPI: 1578295028
Provider Name (Legal Business Name): MELISSA NICOLE LAVENDER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST STE 560
PROVIDENCE RI
02905-3230
US

IV. Provider business mailing address

455 TOLL GATE RD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-7955
  • Fax: 401-453-7720
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMHC01697
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: