Provider Demographics
NPI:1336957430
Name:ESTEVEZ, MELISSA (LCSW-A)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ESTEVEZ
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:PALOMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-A
Mailing Address - Street 1:231 MEMORIAL DR STE AB
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6333
Mailing Address - Country:US
Mailing Address - Phone:910-353-5354
Mailing Address - Fax:910-353-5398
Practice Address - Street 1:231 MEMORIAL DR STE AB
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6333
Practice Address - Country:US
Practice Address - Phone:910-353-5354
Practice Address - Fax:910-353-5398
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0215121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical