Provider Demographics
NPI:1881773570
Name:AUSTIN, MELISSA CLONTZ (NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CLONTZ
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-9016
Mailing Address - Country:US
Mailing Address - Phone:828-396-2493
Mailing Address - Fax:
Practice Address - Street 1:6 PARK SQ
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-1528
Practice Address - Country:US
Practice Address - Phone:828-396-4300
Practice Address - Fax:828-212-0852
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103301Medicaid