=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750191177
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE ROSELYNE DAYAN MA, LPC-R, SOTP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2025
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11548 OLDE TIVERTON CIR APT 202
-----------------------------------------------------
City | RESTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20194-1972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-479-0661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1605 BROOK RD STE B
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23220-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-644-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0704017465
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------