Provider Demographics
NPI:1881441657
Name:RETERSTOFF, MELISSA KATHRYN MABEL
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATHRYN MABEL
Last Name:RETERSTOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KATHRYN MABEL
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:707 N COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4045
Mailing Address - Country:US
Mailing Address - Phone:804-924-2236
Mailing Address - Fax:
Practice Address - Street 1:707 N COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4045
Practice Address - Country:US
Practice Address - Phone:804-924-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional