Provider Demographics
NPI:1730653486
Name:KARSANAC, MELANIE JO (EDS)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JO
Last Name:KARSANAC
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 CARRIAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6518
Mailing Address - Country:US
Mailing Address - Phone:757-263-2700
Mailing Address - Fax:
Practice Address - Street 1:1257 ROSEMONT RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-2119
Practice Address - Country:US
Practice Address - Phone:615-397-7886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813000998103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool