Provider Demographics
NPI:1578708178
Name:WILSON, MELISSA MARIE (LMSW, MPH)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 S FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4022
Mailing Address - Country:US
Mailing Address - Phone:517-410-3287
Mailing Address - Fax:
Practice Address - Street 1:411 W LAKE LANSING RD STE C120
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8483
Practice Address - Country:US
Practice Address - Phone:517-882-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010905811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical