Healthcare Provider Details

I. General information

NPI: 1689049504
Provider Name (Legal Business Name): MELISSA JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA MERRIWEATHER

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 LANGHORNE RD
LYNCHBURG VA
24501-1121
US

IV. Provider business mailing address

620 COURT ST
LYNCHBURG VA
24504-1312
US

V. Phone/Fax

Practice location:
  • Phone: 434-948-4831
  • Fax: 434-485-8877
Mailing address:
  • Phone: 434-948-4831
  • Fax: 434-485-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006407
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: