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NPI Code Detail

MEDICARE: MELISSA ANDERSON

MEDICARE: MELISSA ANDERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker11187SC

General Provider Information

NPI Number : 1750907531
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA ANDERSON
Provider Business Mailing Address
First Line : 1000 JEFFERSON ST STE 2C
Second Line :
City : LYNCHBURG
State : VA
Zip : 24504-1724
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4975 LACROSS RD STE 351
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6530
Country : US
Telephone Number : 800-309-1159
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2020
Last Update Date : 06/17/2020

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