Provider Demographics
NPI:1669139986
Name:LOUIS CONSOLINO, MELANIE ELAINE (LLMSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ELAINE
Last Name:LOUIS CONSOLINO
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 S BURDICK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2712
Mailing Address - Country:US
Mailing Address - Phone:269-552-3440
Mailing Address - Fax:269-552-5586
Practice Address - Street 1:10633 S 27TH ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-9423
Practice Address - Country:US
Practice Address - Phone:269-967-2761
Practice Address - Fax:269-552-5586
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011018241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical