Provider Demographics
NPI:1487372702
Name:BEAVERS, MELISSA DARLENE (LMSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DARLENE
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S GLENWOOD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-3388
Mailing Address - Country:US
Mailing Address - Phone:706-307-0043
Mailing Address - Fax:
Practice Address - Street 1:720 S GLENWOOD AVE STE 104
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-3389
Practice Address - Country:US
Practice Address - Phone:706-307-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical