Provider Demographics
NPI:1144506478
Name:MELTON, MICHELLE L (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:MELTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 BAGLEY CIR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-3126
Mailing Address - Country:US
Mailing Address - Phone:276-783-0833
Mailing Address - Fax:
Practice Address - Street 1:340 BAGLEY CIR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-3126
Practice Address - Country:US
Practice Address - Phone:276-783-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004346103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical