Individual
MELANY W DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
65 PROFESSIONAL PL STE 102, BRIDGEPORT, WV 26330-0259
(304) 848-5770
(304) 848-0890
Mailing address
65 PROFESSIONAL PL STE 102, BRIDGEPORT, WV 26330-0259
(304) 848-5770
(304) 848-0890
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
SW042015479
WV
1041C0700X
Clinical Social Worker
Primary
DP00945736
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DP00945736
LICSW LICENSE
WV
Enumeration date
05/21/2020
Last updated
11/01/2023
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