Provider Demographics
NPI:1336758275
Name:POWELL, MELISSA CARR (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CARR
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2206 WRIGHTSVILLE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2406
Mailing Address - Country:US
Mailing Address - Phone:910-763-6499
Mailing Address - Fax:
Practice Address - Street 1:2206 WRIGHTSVILLE AVE STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2406
Practice Address - Country:US
Practice Address - Phone:910-763-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0167261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical