Provider Demographics
NPI:1184138505
Name:VARGAS, MELISSA MARIE (LMSW, CCS, CAADC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MARIE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LMSW, CCS, CAADC
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 RIVERSIDE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1465
Mailing Address - Country:US
Mailing Address - Phone:517-264-2244
Mailing Address - Fax:517-263-3325
Practice Address - Street 1:770 RIVERSIDE AVE STE 11
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1465
Practice Address - Country:US
Practice Address - Phone:517-264-2244
Practice Address - Fax:517-263-3325
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-03022101YA0400X
171M00000X
MI68010965281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator