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General NPI Number Information
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NPI Number | 1316560345
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Entity Type | Organization
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Legal Business Name | MELIORA THERAPY AND CONSULTING LLC
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 101 LANARK TRL
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-7513
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Country | US
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Telephone | 719-270-1722
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Fax |
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Provider Business Mailing Address
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Address Line | 216 COMMERCE AVE # 189
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-7059
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | DOMINIQUE ALINA DIJKHUIZEN
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Credential | LCSW
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Telephone | 850-502-0671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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