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Individual

MELLISA GAIL DOUGLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.ED,LPC

Contact information

Practice address
71 WILSON BLVD STE A1, FISHERSVILLE, VA 22939-2283
(540) 949-4202
(540) 886-7380
Mailing address
1302 BURNSVILLE RD, WILLIAMSVILLE, VA 24487-2148
(540) 396-3379
(540) 886-7380

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0701004135
VA
101YP2500X
Professional Counselor
17005
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
162090801
TX
Enumeration date
08/22/2006
Last updated
12/02/2013
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