Healthcare Provider Details

I. General information

NPI: 1881386514
Provider Name (Legal Business Name): MELISSA SPEAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 GEORGE WASHINGTON MEM HWY STE F1
YORKTOWN VA
23693-3350
US

IV. Provider business mailing address

3630 GEORGE WASHINGTON MEM HWY STE F1
YORKTOWN VA
23693-3350
US

V. Phone/Fax

Practice location:
  • Phone: 757-241-4407
  • Fax:
Mailing address:
  • Phone: 757-241-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701012615
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: