Provider Demographics
NPI:1457678260
Name:TATE-SCRUSE, MELISSA E (EDD, LCMHCS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:E
Last Name:TATE-SCRUSE
Suffix:
Gender:F
Credentials:EDD, LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 CORONATION BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-6799
Mailing Address - Country:US
Mailing Address - Phone:704-957-3865
Mailing Address - Fax:704-919-0474
Practice Address - Street 1:2210 CORONATION BLVD STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-6799
Practice Address - Country:US
Practice Address - Phone:704-957-3865
Practice Address - Fax:704-919-0474
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC9529101YM0800X
MDLC2087101YM0800X
NCS9529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health