Provider Demographics
NPI:1710414453
Name:WARREN, MELISSA MICHELLE (BSW, MSW, LCSW-A)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MICHELLE
Last Name:WARREN
Suffix:
Gender:F
Credentials:BSW, MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-1914
Mailing Address - Country:US
Mailing Address - Phone:336-451-5320
Mailing Address - Fax:
Practice Address - Street 1:409 BLANDWOOD AVE # 27401
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2705
Practice Address - Country:US
Practice Address - Phone:336-285-7616
Practice Address - Fax:336-285-7868
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0111651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical