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General NPI Number Information
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NPI Number | 1720688088
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Entity Type | Individual
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Provider Name | MELISSA VOLLHARDT MS, LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 150 SOUTHPARK BLVD STE 208
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5179
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Country | US
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Telephone | 904-999-4626
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Fax |
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Provider Business Mailing Address
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Address Line | 36 MADEIRA DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-5343
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Country | US
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Telephone | 904-999-1953
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT4528
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License Number State | FL
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