Provider Demographics
NPI:1083709992
Name:SCULLY, MELISSA EVANS (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:EVANS
Last Name:SCULLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4137
Mailing Address - Country:US
Mailing Address - Phone:540-662-2803
Mailing Address - Fax:540-662-1848
Practice Address - Street 1:123 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4137
Practice Address - Country:US
Practice Address - Phone:540-665-2803
Practice Address - Fax:540-662-1848
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA087956MOtherSENTARA/COM. HEALTH/SOUTH
VA289179OtherANTHEM