Provider Demographics
NPI:1851914105
Name:DAVIS, MELANY W (LICSW)
Entity Type:Individual
Prefix:
First Name:MELANY
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MELANY
Other - Middle Name:W
Other - Last Name:LANGHURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:65 PROFESSIONAL PL STE 102
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-0259
Mailing Address - Country:US
Mailing Address - Phone:304-848-5770
Mailing Address - Fax:304-848-0890
Practice Address - Street 1:65 PROFESSIONAL PL STE 102
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-0259
Practice Address - Country:US
Practice Address - Phone:304-848-5770
Practice Address - Fax:304-848-0890
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSW042015479104100000X
WVDP009457361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDP00945736OtherLICSW LICENSE