Provider Demographics
NPI:1063138519
Name:VAN GROL, MELISSA (LCSW, PPSC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:VAN GROL
Suffix:
Gender:F
Credentials:LCSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BEAR VALLEY PKWY S
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-7699
Mailing Address - Country:US
Mailing Address - Phone:760-291-6086
Mailing Address - Fax:
Practice Address - Street 1:3300 BEAR VALLEY PKWY S
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-7699
Practice Address - Country:US
Practice Address - Phone:760-291-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW85315104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker