Provider Demographics
NPI:1194245654
Name:MASSEY JOHNSON, MELISSA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:MASSEY JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:MASSEY JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:111 N EARLE ST
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:SC
Mailing Address - Zip Code:29691-2419
Mailing Address - Country:US
Mailing Address - Phone:864-916-4349
Mailing Address - Fax:
Practice Address - Street 1:111 N EARLE ST
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691-2419
Practice Address - Country:US
Practice Address - Phone:864-916-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6616101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor