Provider Demographics
NPI:1033731203
Name:GRIFFIN, MELISSA JANE (MAT, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JANE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MAT, BCBA, LBA
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:JANE
Other - Last Name:WALSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAT, BCBA, LBA
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:VA
Mailing Address - Zip Code:20197-0169
Mailing Address - Country:US
Mailing Address - Phone:610-241-5503
Mailing Address - Fax:
Practice Address - Street 1:44927 GEORGE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4295
Practice Address - Country:US
Practice Address - Phone:571-799-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001676103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst