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General NPI Number Information
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NPI Number | 1013421130
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Entity Type | Individual
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Provider Name | MELVIN THOMAS NORMAN JR. BA/LADAC2/QCS/NCAC1/
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Gender | Male
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 119 RACINE ST STE 105
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City | MEMPHIS
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State | TN
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Zip | 38111-2729
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Country | US
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Telephone | 901-230-4047
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Fax | 901-443-5089
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Provider Business Mailing Address
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Address Line | 119 RACINE ST STE 103
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City | MEMPHIS
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State | TN
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Zip | 38111-2729
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Country | US
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Telephone | 901-230-4047
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LDC0000000722
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 722
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License Number State | TN
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