Healthcare Provider Details

I. General information

NPI: 1942899075
Provider Name (Legal Business Name): MELANIE SEXTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 VILLAGE HWY
RUSTBURG VA
24588-4112
US

IV. Provider business mailing address

37 VILLAGE HWY
RUSTBURG VA
24588-4112
US

V. Phone/Fax

Practice location:
  • Phone: 434-332-5149
  • Fax: 434-332-1819
Mailing address:
  • Phone: 434-332-5149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12955267-6004
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010165
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: