Healthcare Provider Details

I. General information

NPI: 1386177111
Provider Name (Legal Business Name): MELISSA RIOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2017
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5048 SIGNATURE CT
HAYMARKET VA
20169-2674
US

IV. Provider business mailing address

2100 WASHINGTON BLVD FL 3
ARLINGTON VA
22204-5717
US

V. Phone/Fax

Practice location:
  • Phone: 808-222-0884
  • Fax:
Mailing address:
  • Phone: 808-222-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904016131
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: