Provider Demographics
NPI:1538552807
Name:GARDINER, MELISSA (MA, LLPC LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GARDINER
Suffix:
Gender:F
Credentials:MA, LLPC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 GENES DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-1902
Mailing Address - Country:US
Mailing Address - Phone:248-390-4594
Mailing Address - Fax:
Practice Address - Street 1:2670 GENES DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1902
Practice Address - Country:US
Practice Address - Phone:248-390-4594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency