Provider Demographics
NPI:1053879171
Name:MELTON, LOGAN (LPCA)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3648 ARTEE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-7760
Mailing Address - Country:US
Mailing Address - Phone:704-472-4551
Mailing Address - Fax:
Practice Address - Street 1:172 S OAK ST
Practice Address - Street 2:SUITE C
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-1690
Practice Address - Country:US
Practice Address - Phone:704-466-0162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional