1639708704 NPI number — MRS. MELISSA A. GRIFFITH CROOKS

Table of content: MRS. MELISSA A. GRIFFITH CROOKS (NPI 1639708704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639708704 NPI number — MRS. MELISSA A. GRIFFITH CROOKS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROOKS
Provider First Name:
MELISSA
Provider Middle Name:
A. GRIFFITH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639708704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26036 IVERSON DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH RIDING
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-244-1679
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
IN LUCK COUNSELING, LLC
Provider Second Line Business Practice Location Address:
92 MAIN STREET
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-997-6641
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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