Provider Demographics
NPI:1124240833
Name:HASKINS, MELISSA (CADC II)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HASKINS
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15345 CARRIE DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-6407
Mailing Address - Country:US
Mailing Address - Phone:530-272-1298
Mailing Address - Fax:
Practice Address - Street 1:34248 E. TOWLE RD.
Practice Address - Street 2:
Practice Address - City:ALTA
Practice Address - State:CA
Practice Address - Zip Code:95701-1150
Practice Address - Country:US
Practice Address - Phone:530-389-9208
Practice Address - Fax:530-389-9209
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA4002207101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)