Provider Demographics
NPI:1720212988
Name:WILLIS, MELISSA ANTOINETTE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANTOINETTE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 INGRAHAM ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2904
Mailing Address - Country:US
Mailing Address - Phone:202-576-6202
Mailing Address - Fax:202-576-6205
Practice Address - Street 1:800 INGRAHAM ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2904
Practice Address - Country:US
Practice Address - Phone:202-576-6202
Practice Address - Fax:202-576-6205
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500793411041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool