Provider Demographics
NPI:1255429445
Name:GORDON-PITTS, MELISSA RAE (LCSW-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAE
Last Name:GORDON-PITTS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RAE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4921 PROFESSIONAL CT
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4913
Mailing Address - Country:US
Mailing Address - Phone:877-278-7317
Mailing Address - Fax:877-278-7317
Practice Address - Street 1:4921 PROFESSIONAL CT
Practice Address - Street 2:SUITE 201B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4913
Practice Address - Country:US
Practice Address - Phone:877-278-7317
Practice Address - Fax:877-278-7317
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136721041C0700X
NCC0100201041C0700X
VA09040086721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413568700Medicaid
MD191NMedicare UPIN