Provider Demographics
NPI:1427404813
Name:CARROLL, MELISSA DAY (LICSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAY
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DAY
Other - Last Name:HERSCHBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9708 NE 26TH PL
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-5733
Mailing Address - Country:US
Mailing Address - Phone:360-574-9303
Mailing Address - Fax:
Practice Address - Street 1:2103 NE 129TH ST STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3270
Practice Address - Country:US
Practice Address - Phone:360-574-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610280281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical