Provider Demographics
NPI:1548715154
Name:WOMBLE, MELISSA NICOLE (PHD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICOLE
Last Name:WOMBLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4617
Mailing Address - Country:US
Mailing Address - Phone:703-970-6458
Mailing Address - Fax:703-970-6465
Practice Address - Street 1:8501 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4617
Practice Address - Country:US
Practice Address - Phone:703-970-6458
Practice Address - Fax:703-970-6465
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005316103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist