Healthcare Provider Details

I. General information

NPI: 1699637041
Provider Name (Legal Business Name): MELISSA WEIERICK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 MIDDLEBURG DR STE 212
COLUMBIA SC
29204-2486
US

IV. Provider business mailing address

2711 MIDDLEBURG DR STE 212
COLUMBIA SC
29204-2486
US

V. Phone/Fax

Practice location:
  • Phone: 803-234-6134
  • Fax:
Mailing address:
  • Phone: 803-234-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16308
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: