Provider Demographics
NPI:1154658722
Name:ROSE, MELINA (LCSW)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2440
Mailing Address - Country:US
Mailing Address - Phone:731-608-4141
Mailing Address - Fax:800-948-9003
Practice Address - Street 1:587 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2440
Practice Address - Country:US
Practice Address - Phone:731-608-4141
Practice Address - Fax:800-948-9003
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW57141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical