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General NPI Number Information
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NPI Number | 1487008199
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Entity Type | Organization
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Legal Business Name | MELISSA FITHIAN, LLC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 249 S DELSEA DR
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City | CLAYTON
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State | NJ
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Zip | 08312-2203
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Country | US
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Telephone | 856-244-1162
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Fax |
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Provider Business Mailing Address
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Address Line | 512 DEMOSS CT
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City | GLASSBORO
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State | NJ
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Zip | 08028-3014
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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 | FOUNDER/DIRECTOR
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Name | MELISSA FITHIAN
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Credential |
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Telephone | 609-980-6028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 37PC00532100
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License Number State | NJ
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