Provider Demographics
NPI:1407626062
Name:JACKSON, MELISSA ELIZABETH (MSW)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 NEABSCO COMMON PL APT 321
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6781
Mailing Address - Country:US
Mailing Address - Phone:973-527-1896
Mailing Address - Fax:
Practice Address - Street 1:19 E MARKET ST STE 301
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3001
Practice Address - Country:US
Practice Address - Phone:973-527-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060149971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical