Provider Demographics
NPI:1861500092
Name:ANDERSON, MELISSA BETH (LCSW, LSATP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 MIDSHIPMAN CIR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-2421
Mailing Address - Country:US
Mailing Address - Phone:540-659-5330
Mailing Address - Fax:
Practice Address - Street 1:2200 OPITZ BLVD
Practice Address - Street 2:SUITE 345
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3321
Practice Address - Country:US
Practice Address - Phone:703-967-5479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000067101YA0400X
VA09040028381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical