Provider Demographics
NPI:1942645429
Name:PETERS, MELISSA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:PETERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42102 FIDDLEHEAD PL
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3007
Mailing Address - Country:US
Mailing Address - Phone:703-989-3409
Mailing Address - Fax:
Practice Address - Street 1:25152 ELK LICK RD STE 220
Practice Address - Street 2:
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-4507
Practice Address - Country:US
Practice Address - Phone:703-989-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040052061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical