Provider Demographics
NPI:1720367121
Name:CLAS, MELISSA S (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:CLAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N. LYNNHAVEN RD
Mailing Address - Street 2:STE 201
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452
Mailing Address - Country:US
Mailing Address - Phone:757-672-1815
Mailing Address - Fax:757-215-2385
Practice Address - Street 1:101 N. LYNNHAVEN RD
Practice Address - Street 2:STE 201
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-672-1815
Practice Address - Fax:757-215-2385
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1861562472Medicaid