MEDICARE: DR. MELANIE AVERY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810005743	VA

General Provider Information

NPI Number	:	1891192944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELANIE AVERY PH.D.

Provider Business Mailing Address
First Line	:	454 REGENCY PARK DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-4060
Country	:	US
Telephone Number	:	301-710-8845
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 N COURTHOUSE RD STE 101
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4069
Country	:	US
Telephone Number	:
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2014
Last Update Date	:	10/10/2017

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