Provider Demographics
NPI:1588248108
Name:ROSS, SHENITA MELVIN (DHA, MSW, LCSWA)
Entity type:Individual
Prefix:DR
First Name:SHENITA
Middle Name:MELVIN
Last Name:ROSS
Suffix:
Gender:F
Credentials:DHA, MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 EXECUTIVE PL STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5183
Mailing Address - Country:US
Mailing Address - Phone:910-785-2109
Mailing Address - Fax:
Practice Address - Street 1:584 EXECUTIVE PL STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5183
Practice Address - Country:US
Practice Address - Phone:910-785-2109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0158831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical