Healthcare Provider Details

I. General information

NPI: 1053318204
Provider Name (Legal Business Name): MELISSA MICHELE SCHOTT LCSW LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

4747 BRANT RD
COLORADO SPRINGS CO
80911-3173
US

V. Phone/Fax

Practice location:
  • Phone: 571-432-2780
  • Fax: 571-231-6762
Mailing address:
  • Phone: 719-338-7214
  • Fax: 719-475-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD-106
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-218
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-128
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: