Provider Demographics
NPI:1447639315
Name:SHERLOCK, MELISSA (MA, CADC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SHERLOCK
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CADC
Mailing Address - Street 1:1148 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4359
Mailing Address - Country:US
Mailing Address - Phone:717-390-9086
Mailing Address - Fax:717-390-9066
Practice Address - Street 1:321 N MARKET ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3003
Practice Address - Country:US
Practice Address - Phone:717-394-5334
Practice Address - Fax:717-394-8747
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1102899457Medicaid