Provider Demographics
NPI:1184005225
Name:PHILLIPS, MELANIE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ELIZABETH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ELIZABETH
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 CHILDREN'S LANE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-7525
Mailing Address - Fax:757-668-9077
Practice Address - Street 1:601 CHILDREN'S LANE
Practice Address - Street 2:THE CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS SOCIAL
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7525
Practice Address - Fax:757-668-9077
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904008955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional