Provider Demographics
NPI:1588191068
Name:BURRISS, MELINDA DIXON
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:DIXON
Last Name:BURRISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140D LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2305
Mailing Address - Country:US
Mailing Address - Phone:276-236-6341
Mailing Address - Fax:276-236-6237
Practice Address - Street 1:140D LARKSPUR LN
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2305
Practice Address - Country:US
Practice Address - Phone:276-236-6341
Practice Address - Fax:276-236-6237
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)