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General NPI Number Information
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NPI Number | 1336188655
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Entity Type | Individual
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Provider Name | MELISSA SUE PROCTOR LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 8804 PATTERSON AVE
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City | RICHMOND
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State | VA
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Zip | 23229-6361
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Country | US
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Telephone | 804-592-6311
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Fax |
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Provider Business Mailing Address
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Address Line | 815 PORTER ST APT 308
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City | RICHMOND
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State | VA
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Zip | 23224-2272
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Country | US
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Telephone | 619-929-4921
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 62650
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904015618
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 4948
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License Number State | KY
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