Basic Information
| Provider Information | |||||||||
| NPI: | 1306966486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COX | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | GENT | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9054 | ||||||||
| Address2: | |||||||||
| City: | GRAY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376159054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234673600 | ||||||||
| FaxNumber: | 4234673644 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242013201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238446000 | ||||||||
| FaxNumber: | 4238446027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 0904003815 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 4542 | TN | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.