Provider Demographics
NPI:1134886120
Name:CARLSON, MELISSA (RBT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 CROWNE CREEK DR APT 202
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-8309
Mailing Address - Country:US
Mailing Address - Phone:703-725-8854
Mailing Address - Fax:
Practice Address - Street 1:6121 CROWNE CREEK DR APT 202
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-8309
Practice Address - Country:US
Practice Address - Phone:703-725-8854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst