Provider Demographics
NPI:1962377853
Name:DACIUK, MELISSA (PSYD, LPC-A)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:DACIUK
Suffix:
Gender:F
Credentials:PSYD, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SAVANNAH RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8848
Mailing Address - Country:US
Mailing Address - Phone:704-408-9111
Mailing Address - Fax:
Practice Address - Street 1:1714 S LIVE OAK DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-7215
Practice Address - Country:US
Practice Address - Phone:843-879-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional