Individual
MRS. MELISSA JO BIRDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2001 STONEBROOK PL, KINGSPORT, TN 37660
(423) 224-1000
(423) 224-1023
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3696
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LCSW0000004543
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178143
ANTHEM PREF TRIGON
—
01
—
334969
VALUE OPTIONS
—
01
—
359996
MANAGED HEALTH NET
—
01
—
4103787
MAGELLAN NAVIGATOR
—
01
—
5631185
FIRST HEALTH
—
Enumeration date
09/12/2006
Last updated
07/08/2007
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