Provider Demographics
NPI:1174950414
Name:MELVIN, JEANNE MALMGREN (MED, NCC, LPC-I)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:MALMGREN
Last Name:MELVIN
Suffix:
Gender:F
Credentials:MED, NCC, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W NORTH 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-3250
Mailing Address - Country:US
Mailing Address - Phone:864-784-1077
Mailing Address - Fax:
Practice Address - Street 1:206 W NORTH 1ST ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3250
Practice Address - Country:US
Practice Address - Phone:864-784-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health