Basic Information
| Provider Information | |||||||||
| NPI: | 1841598422 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINCICOME | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 726 20TH ST | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329605442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722575264 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 726 20TH ST | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722575264 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2011 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E0700904 | OH | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | MH16623 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | IMH5303 | FL | N | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | E0700904 | 01 | OH | COUNSELING BOARD | OTHER | MH16623 | 01 | FL | FLORIDA BOARD OF MENTAL HEALTH COUNSELING | OTHER |