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General NPI Number Information
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NPI Number | 1316474430
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Entity Type | Individual
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Provider Name | MELODY CARR MED, LPCA
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Gender | Female
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 05/19/2017
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Provider Practice Location Address
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Address Line | 105 WAXHAW PROFESSIONAL PARK DR STE H
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City | WAXHAW
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State | NC
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Zip | 28173-5018
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Country | US
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Telephone | 704-256-0305
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Fax | 704-256-9968
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Provider Business Mailing Address
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Address Line | 2359 FERNRIDGE LN
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City | MATTHEWS
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State | NC
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Zip | 28105-5881
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Country | US
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Telephone | 706-399-9121
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A12960
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License Number State | NC
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