Provider Demographics
NPI:1902391378
Name:DRISCOLL, MELANIE C (LLMSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:C
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18224 W 12 MILE RD APT 304
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2667
Mailing Address - Country:US
Mailing Address - Phone:248-938-5162
Mailing Address - Fax:
Practice Address - Street 1:5500 AUTO CLUB DR STE 350
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2779
Practice Address - Country:US
Practice Address - Phone:313-217-2000
Practice Address - Fax:313-217-2090
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68011162581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker