Provider Demographics
NPI:1629868674
Name:WILSON-BASKETT, MELISSA L (LMHP-R)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:WILSON-BASKETT
Suffix:
Gender:F
Credentials:LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 BURNHAM DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-1609
Mailing Address - Country:US
Mailing Address - Phone:843-499-5170
Mailing Address - Fax:
Practice Address - Street 1:2010 OLD GREENBRIER RD STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2619
Practice Address - Country:US
Practice Address - Phone:757-702-3261
Practice Address - Fax:757-702-3260
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health