Provider Demographics
NPI:1417682543
Name:SOULE, MELISSA SUE (MA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:SOULE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 REMOUNT RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-3320
Mailing Address - Country:US
Mailing Address - Phone:843-882-6880
Mailing Address - Fax:843-892-0394
Practice Address - Street 1:1495 REMOUNT RD STE 3A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-3320
Practice Address - Country:US
Practice Address - Phone:843-882-6880
Practice Address - Fax:843-892-0394
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1651378101Y00000X
SC8874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor