Provider Demographics
NPI:1215175567
Name:DYKSTRA, MELISSA GEAN (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GEAN
Last Name:DYKSTRA
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 1:710 DUNCAN AVE APT 1415
Mailing Address - Street 2:PITTSBURGH
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5062
Mailing Address - Country:US
Mailing Address - Phone:412-548-3319
Mailing Address - Fax:
Practice Address - Street 1:710 DUNCAN AVE APT 1415
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5062
Practice Address - Country:US
Practice Address - Phone:866-482-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-24
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0159361041C0700X
MI68010854051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical