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General NPI Number Information
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NPI Number | 1649107707
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Entity Type | Individual
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Provider Name | MELONEY WILSON CDCAPRE.195839
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Gender |
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 6770 AVERY MUIRFIELD DR
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City | DUBLIN
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State | OH
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Zip | 43017-1241
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Country | US
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Telephone | 888-251-2365
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Fax |
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Provider Business Mailing Address
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Address Line | 116 HARVARD AVE
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City | MANSFIELD
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State | OH
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Zip | 44906-2819
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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 |
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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 | CDCAPRE.195839
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License Number State | OH
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