Provider Demographics
NPI:1225791932
Name:DIAZ, MELISSA JANE (MS, SHRM-CP, RCSWI)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JANE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MS, SHRM-CP, RCSWI
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:JANE
Other - Last Name:WILHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:700 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1017
Mailing Address - Country:US
Mailing Address - Phone:517-962-4815
Mailing Address - Fax:517-888-5943
Practice Address - Street 1:700 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1017
Practice Address - Country:US
Practice Address - Phone:517-962-4815
Practice Address - Fax:517-888-5943
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60200349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health