Provider Demographics
NPI:1780827600
Name:MONTBLANC, MELISSA A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:MONTBLANC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:WAKEFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 OLYMPIC BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596
Mailing Address - Country:US
Mailing Address - Phone:625-566-2300
Mailing Address - Fax:360-695-3436
Practice Address - Street 1:1901 OLYMPIC BLVD
Practice Address - Street 2:STE 120
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:625-566-2300
Practice Address - Fax:360-695-3436
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPENDING101YM0800X
CA292531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health