Provider Demographics
NPI:1144504960
Name:THOMPSON, MELISSA LYNN
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11401 FAWNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-8178
Mailing Address - Country:US
Mailing Address - Phone:616-836-4313
Mailing Address - Fax:
Practice Address - Street 1:1415 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3009
Practice Address - Country:US
Practice Address - Phone:540-662-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
VAPPS-0606403103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst