Provider Demographics
NPI:1942773031
Name:MILLER, MELISSA (LISW, LICDC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, LCDC III
Mailing Address - Street 1:5550 HIGH POINT CT
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2041
Mailing Address - Country:US
Mailing Address - Phone:440-263-6343
Mailing Address - Fax:
Practice Address - Street 1:3681 GREEN RD STE 404
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5716
Practice Address - Country:US
Practice Address - Phone:440-263-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
OHLCDCIII.161859101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)