Provider Demographics
NPI:1639450091
Name:YATES, MELISSA (LCSWA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-9198
Mailing Address - Country:US
Mailing Address - Phone:443-306-5362
Mailing Address - Fax:
Practice Address - Street 1:1140 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:VASS
Practice Address - State:NC
Practice Address - Zip Code:28394-9198
Practice Address - Country:US
Practice Address - Phone:443-306-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0197531041C0700X
1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical