Provider Demographics
NPI:1922566819
Name:ANDREWS, MELISSA LYNNE (LMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNNE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 CROFTON ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-8029
Mailing Address - Country:US
Mailing Address - Phone:616-516-1159
Mailing Address - Fax:
Practice Address - Street 1:627 CROFTON ST SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-8029
Practice Address - Country:US
Practice Address - Phone:616-516-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-09
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011018111041C0700X
MI68011064781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical