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General NPI Number Information
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NPI Number | 1093060022
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Entity Type | Individual
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Provider Name | DONNA L. MELDRUM MA, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 117 CASS AVE SUITE 300
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2252
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Country | US
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Telephone | 586-260-7835
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Fax | 586-468-5270
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Provider Business Mailing Address
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Address Line | 117 CASS AVENUE SUITE 300
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City | MT. CLEMENS
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State | MI
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Zip | 48043
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Country | US
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Telephone | 586-260-7835
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Fax | 586-468-5270
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401011811
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 6401011811
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License Number State | MI
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