Provider Demographics
NPI:1598302523
Name:MELYSSA MANOCK, MSW, MLADC, LLC
Entity Type:Organization
Organization Name:MELYSSA MANOCK, MSW, MLADC, LLC
Other - Org Name:INNATE THERAPEUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MLADC
Authorized Official - Phone:603-724-0038
Mailing Address - Street 1:67 INDUSTRIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-2507
Mailing Address - Country:US
Mailing Address - Phone:603-671-7045
Mailing Address - Fax:603-556-8546
Practice Address - Street 1:67 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-2507
Practice Address - Country:US
Practice Address - Phone:603-671-7045
Practice Address - Fax:603-556-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1174083455Medicaid