Healthcare Provider Details

I. General information

NPI: 1619895349
Provider Name (Legal Business Name): MELISSA ANNE DERRENBACHER MA, LPC, NCC, C-DBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 BENTON CIR
CAYCE SC
29033-2402
US

IV. Provider business mailing address

1524 BENTON CIR
CAYCE SC
29033-2402
US

V. Phone/Fax

Practice location:
  • Phone: 803-250-5378
  • Fax:
Mailing address:
  • Phone: 803-250-5378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12233
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: