Provider Demographics
NPI:1346562253
Name:WEAVER, MELISSA ANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:WEAVER
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 1:9702 GAYTON RD
Mailing Address - Street 2:#181
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4907
Mailing Address - Country:US
Mailing Address - Phone:804-363-4224
Mailing Address - Fax:804-288-0705
Practice Address - Street 1:9702 GAYTON RD
Practice Address - Street 2:#181
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4907
Practice Address - Country:US
Practice Address - Phone:804-363-4224
Practice Address - Fax:804-288-0705
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040072981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical