Provider Demographics
NPI:1457162752
Name:ACKLEY, MELISSA KAST (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAST
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12810 FRAMAR DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-9628
Mailing Address - Country:US
Mailing Address - Phone:804-937-7068
Mailing Address - Fax:
Practice Address - Street 1:1700 HUGUENOT RD STE 1C
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2397
Practice Address - Country:US
Practice Address - Phone:804-464-7287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040040311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical