Provider Demographics
NPI:1336180660
Name:WALDRIP, MELISSA E (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:E
Last Name:WALDRIP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:E
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2851 S AVE B
Mailing Address - Street 2:BLDG. 4
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7726
Mailing Address - Country:US
Mailing Address - Phone:928-376-0026
Mailing Address - Fax:
Practice Address - Street 1:2851 S AVE B
Practice Address - Street 2:BLDG. 4
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7726
Practice Address - Country:US
Practice Address - Phone:928-376-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-17121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ589492OtherAHCCCS #
AZ74477Medicare ID - Type UnspecifiedYUMA COUNTY