Provider Demographics
NPI:1902283088
Name:DARDIZ, MELISSA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:DARDIZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4090 DELTONA BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-2203
Mailing Address - Country:US
Mailing Address - Phone:352-403-4115
Mailing Address - Fax:352-666-4053
Practice Address - Street 1:4090 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2203
Practice Address - Country:US
Practice Address - Phone:352-403-4115
Practice Address - Fax:352-666-4053
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15044101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8130672276Medicaid