Provider Demographics
NPI:1275797912
Name:MELLION, AMINAH SHAKURAH (LCSW)
Entity Type:Individual
Prefix:
First Name:AMINAH
Middle Name:SHAKURAH
Last Name:MELLION
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMINAH
Other - Middle Name:SHAKURAH
Other - Last Name:MUHAMMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 N SAINT ASAPH ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1912
Mailing Address - Country:US
Mailing Address - Phone:703-746-3444
Mailing Address - Fax:
Practice Address - Street 1:720 N SAINT ASAPH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1912
Practice Address - Country:US
Practice Address - Phone:703-746-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500785601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1447279658Medicaid