Provider Demographics
NPI:1043421837
Name:SAVAGE, MELISSA (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11474 RACINE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-6566
Mailing Address - Country:US
Mailing Address - Phone:586-258-0206
Mailing Address - Fax:586-258-0201
Practice Address - Street 1:12220 E 13 MILE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5000
Practice Address - Country:US
Practice Address - Phone:586-258-0206
Practice Address - Fax:586-258-0201
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health