Healthcare Provider Details

I. General information

NPI: 1750191177
Provider Name (Legal Business Name): MELANIE ROSELYNE DAYAN MA, LPC-R, SOTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11548 OLDE TIVERTON CIR APT 202
RESTON VA
20194-1972
US

IV. Provider business mailing address

1605 BROOK RD STE B
RICHMOND VA
23220-1801
US

V. Phone/Fax

Practice location:
  • Phone: 571-479-0661
  • Fax:
Mailing address:
  • Phone: 804-644-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704017465
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: