Individual
MELONIE DIANE BEAVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5240 MACCORKLE AVE SE, CHARLESTON, WV 25304-2122
(304) 926-2300
(304) 926-2304
Mailing address
PO BOX 116, JOLO, WV 24850-0116
(304) 890-3005
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2479
WV
Other
Enumeration date
02/28/2020
Last updated
11/05/2020
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