Provider Demographics
NPI:1508012618
Name:BUSNOT, MELISSA CARR (LCSW, CEAP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CARR
Last Name:BUSNOT
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 ORIENTAL GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4255
Mailing Address - Country:US
Mailing Address - Phone:904-614-2802
Mailing Address - Fax:
Practice Address - Street 1:4741 ATLANTIC BLVD STE B3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2168
Practice Address - Country:US
Practice Address - Phone:904-614-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-09
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW44721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical