Provider Demographics
NPI:1316660608
Name:STULTZ, MELISSA ERIN (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ERIN
Last Name:STULTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:ERIN
Other - Last Name:STULTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:437 PERKINS ST APT 207
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4733
Mailing Address - Country:US
Mailing Address - Phone:510-279-0818
Mailing Address - Fax:
Practice Address - Street 1:437 PERKINS ST APT 207
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4733
Practice Address - Country:US
Practice Address - Phone:510-279-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1271061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical