Provider Demographics
NPI:1932512456
Name:DRINKMAN, MELISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DRINKMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 W CINNABAR AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6894
Mailing Address - Country:US
Mailing Address - Phone:602-218-1249
Mailing Address - Fax:623-321-9964
Practice Address - Street 1:7007 W CINNABAR AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6894
Practice Address - Country:US
Practice Address - Phone:602-218-1249
Practice Address - Fax:623-321-9964
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 141361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ920264Medicaid
AZ920264Medicaid