Healthcare Provider Details

I. General information

NPI: 1972167294
Provider Name (Legal Business Name): MELISSA CALLAHAM LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EAST OCEAN BLVD. SUITE D-130, OFFICE 26
STUART FL
34994
US

IV. Provider business mailing address

900 EAST OCEAN BLVD. SUITE D-130, OFFICE 26
STUART FL
34994
US

V. Phone/Fax

Practice location:
  • Phone: 772-204-5260
  • Fax:
Mailing address:
  • Phone: 772-204-5260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MELISSA CALLAHAM
Title or Position: OWNER
Credential: LCSW
Phone: 772-204-5260