Provider Demographics
NPI:1689024804
Name:TUTTLE, MELISSA DEAN (MSW, LCSWA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:DEAN
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 SUNDOWN DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4951
Mailing Address - Country:US
Mailing Address - Phone:336-202-6816
Mailing Address - Fax:
Practice Address - Street 1:430 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2104
Practice Address - Country:US
Practice Address - Phone:336-337-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0106491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical