Provider Demographics
NPI:1053897389
Name:MELISA POOL, LCSW-C, LLC
Entity type:Organization
Organization Name:MELISA POOL, LCSW-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:POOL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-834-5293
Mailing Address - Street 1:2881 SAINT JOHNS LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2551
Mailing Address - Country:US
Mailing Address - Phone:443-834-5293
Mailing Address - Fax:410-480-0110
Practice Address - Street 1:2881 SAINT JOHNS LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2551
Practice Address - Country:US
Practice Address - Phone:443-834-5293
Practice Address - Fax:410-480-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty