Healthcare Provider Details

I. General information

NPI: 1700759487
Provider Name (Legal Business Name): MELODY K SCOTT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 NUCKOLS RD STE 100
GLEN ALLEN VA
23060-9276
US

IV. Provider business mailing address

10900 NUCKOLS RD STE 100
GLEN ALLEN VA
23060-9276
US

V. Phone/Fax

Practice location:
  • Phone: 855-949-5998
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701014478
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014478
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: