Individual
MELODY SUE NOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
2045 SILVERTON RD NE STE A, SALEM, OR 97301-0100
(503) 576-4660
(503) 361-2688
Mailing address
2045 SILVERTON RD NE STE A, SALEM, OR 97301-0100
(503) 576-4660
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-20-340
OR
175T00000X
Peer Specialist
17-CRM-110
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263634042
—
OR
Enumeration date
12/15/2017
Last updated
10/06/2020
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