Provider Demographics
NPI:1851158711
Name:ACOSTA, MELISSA (CADAC II)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:CADAC II
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADAC II
Mailing Address - Street 1:1964 W DEER RUN
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-7937
Mailing Address - Country:US
Mailing Address - Phone:812-605-0381
Mailing Address - Fax:
Practice Address - Street 1:7509 CHARLESTOWN PIKE
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-9623
Practice Address - Country:US
Practice Address - Phone:812-256-4686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-5198101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)