Provider Demographics
NPI:1487811279
Name:PATELLA, MELANIE JOHNSON (LPC)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:JOHNSON
Last Name:PATELLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ELIZABETH
Other - Last Name:PATELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHC
Mailing Address - Street 1:650 PETREE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3507
Mailing Address - Country:US
Mailing Address - Phone:336-765-1853
Mailing Address - Fax:
Practice Address - Street 1:650 PETREE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3507
Practice Address - Country:US
Practice Address - Phone:704-743-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4723101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor