Provider Demographics
NPI:1558696468
Name:SCALES, TODD AMECILO (BA; QP)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:AMECILO
Last Name:SCALES
Suffix:
Gender:M
Credentials:BA; QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 ALBEMARLE RD
Mailing Address - Street 2:107
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6668
Mailing Address - Country:US
Mailing Address - Phone:980-939-8061
Mailing Address - Fax:
Practice Address - Street 1:4822 ALBEMARLE RD
Practice Address - Street 2:107
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6668
Practice Address - Country:US
Practice Address - Phone:980-939-8061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105-366101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health