Healthcare Provider Details

I. General information

NPI: 1336069608
Provider Name (Legal Business Name): MELISSA MELROY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 CHESTNUT RD
MYRTLE BEACH SC
29572-5502
US

IV. Provider business mailing address

505 RIVER RD
CONWAY SC
29526-7934
US

V. Phone/Fax

Practice location:
  • Phone: 484-366-5189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15356
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: