Provider Demographics
NPI:1063125367
Name:JOHNSTON-ENZOR, MELISSA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:JOHNSTON-ENZOR
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 1:27011 ARROWBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7431
Mailing Address - Country:US
Mailing Address - Phone:813-334-0876
Mailing Address - Fax:
Practice Address - Street 1:27011 ARROWBROOK WAY
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7431
Practice Address - Country:US
Practice Address - Phone:813-444-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7868561041S0200X
FLSW196881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool