Healthcare Provider Details

I. General information

NPI: 1649094087
Provider Name (Legal Business Name): MELONIE SUE DOLIN LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 HARMONS CREEK RD
POCA WV
25159-9089
US

IV. Provider business mailing address

509 HARMONS CREEK RD
POCA WV
25159-9089
US

V. Phone/Fax

Practice location:
  • Phone: 304-951-2487
  • Fax:
Mailing address:
  • Phone: 304-951-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3030
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: