Healthcare Provider Details

I. General information

NPI: 1225484280
Provider Name (Legal Business Name): MELISSA DONOHUE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA MELAMUD

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 PROFESSIONAL CT
MARTINSBURG WV
25401-8808
US

IV. Provider business mailing address

164 ASHLEY DR
SHEPHERDSTOWN WV
25443-4617
US

V. Phone/Fax

Practice location:
  • Phone: 304-596-5780
  • Fax:
Mailing address:
  • Phone: 305-607-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1293
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: