Healthcare Provider Details

I. General information

NPI: 1679521009
Provider Name (Legal Business Name): SHERESA S. MELVIN LPC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. SHERESA S. ARRINGTON

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SWCMHC/KERSHAW CMHC, 2611 LIBERTY HILL RD.
CAMDEN SC
29020
US

IV. Provider business mailing address

SWCMHC, 215 N. MAGNOLIA ST.
SUMTER SC
29151-1946
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-5323
  • Fax: 803-713-3978
Mailing address:
  • Phone: 803-775-9364
  • Fax: 803-773-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4705
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: