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General NPI Number Information
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NPI Number | 1821893017
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Entity Type | Organization
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Legal Business Name | MELANIN THERAPY AND WELLNESS PRACTICE
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 606 TRILLIUM CT SW
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City | CONOVER
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State | NC
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Zip | 28613-7913
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Country | US
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Telephone | 704-251-7217
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Fax |
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Provider Business Mailing Address
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Address Line | 224 TURNERSBURG HWY # 1052
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City | STATESVILLE
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State | NC
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Zip | 28625-2797
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Country | US
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Telephone | 704-251-7217
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MIA REDMOND
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Credential |
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Telephone | 704-251-7217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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