Provider Demographics
NPI:1083716427
Name:PRICE, MELODY ELISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:ELISE
Last Name:PRICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 WHEAT AVE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4321
Mailing Address - Country:US
Mailing Address - Phone:229-416-4421
Mailing Address - Fax:
Practice Address - Street 1:509 WHEAT AVE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4321
Practice Address - Country:US
Practice Address - Phone:229-416-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW004003104100000X
GACSW0079161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW007916OtherGA LICENSE