Individual
MELODY MICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 BROAD ROCK BOULEVARD, 2B-271, RICHMOND, VA 23294-4915
(804) 675-5000
Mailing address
1201 BROAD ROCK BLVD, RICHMOND, VA 23103
(804) 337-2146
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810005496
VA
Other
Enumeration date
09/23/2016
Last updated
09/23/2016
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