Provider Demographics
NPI:1962113530
Name:MORRISON, MELISSA DAWN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 SALUDA ST
Mailing Address - Street 2:
Mailing Address - City:NINETY SIX
Mailing Address - State:SC
Mailing Address - Zip Code:29666-1145
Mailing Address - Country:US
Mailing Address - Phone:864-992-4399
Mailing Address - Fax:
Practice Address - Street 1:245 SALUDA ST
Practice Address - Street 2:
Practice Address - City:NINETY SIX
Practice Address - State:SC
Practice Address - Zip Code:29666-1145
Practice Address - Country:US
Practice Address - Phone:864-992-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17-35851106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician