Basic Information
| Provider Information | |||||||||
| NPI: | 1053065615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELTON | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | EDNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4812 TRADD CIR | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281105644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9803284628 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6115 HICKORY GROVE RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282154207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045324262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2022 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 14130 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.