Provider Demographics
NPI:1043737927
Name:HINES, MELISSA SUE (MSW, LICSW, LCSWC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:SUE
Last Name:HINES
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 3122
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-9413
Mailing Address - Country:US
Mailing Address - Phone:304-788-2342
Mailing Address - Fax:304-788-2409
Practice Address - Street 1:108 STATELY ST
Practice Address - Street 2:
Practice Address - City:WILEY FORD
Practice Address - State:WV
Practice Address - Zip Code:26767
Practice Address - Country:US
Practice Address - Phone:304-582-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009434581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical