Provider Demographics
NPI:1043789126
Name:HEUSTESS, MELISSA (LCSWA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HEUSTESS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ORANGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9326
Mailing Address - Country:US
Mailing Address - Phone:804-263-1063
Mailing Address - Fax:800-272-4875
Practice Address - Street 1:20 ORANGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9326
Practice Address - Country:US
Practice Address - Phone:804-263-1063
Practice Address - Fax:800-272-4875
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-18
Last Update Date:2018-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP013085104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker