Provider Demographics
NPI:1861586299
Name:WHITE, MELISSA SUZANNE (MA)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:SUZANNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 WILSON ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1948
Mailing Address - Country:US
Mailing Address - Phone:253-223-1798
Mailing Address - Fax:
Practice Address - Street 1:509 WILSON ST SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1948
Practice Address - Country:US
Practice Address - Phone:253-223-1798
Practice Address - Fax:253-589-5139
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health