Individual
MELISSA COLLINGSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700
(260) 481-2709
Mailing address
5904 E STATE BLVD, FORT WAYNE, IN 46815-7637
(260) 203-9185
(260) 203-9187
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
104100000X
Social Worker
33007721A
IN
1041C0700X
Clinical Social Worker
34009112A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34009112A
INDIANA BEHAVIORAL HEALTH BOARD
IN
Enumeration date
11/20/2014
Last updated
09/13/2021
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