Provider Demographics
NPI:1083819395
Name:HEAD, MELODIE ANNE (OR DESANTO)
Entity Type:Individual
Prefix:MS
First Name:MELODIE
Middle Name:ANNE (OR DESANTO)
Last Name:HEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 VILLAGE CREEK DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4160
Mailing Address - Country:US
Mailing Address - Phone:770-381-1273
Mailing Address - Fax:
Practice Address - Street 1:733 VILLAGE CREEK DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4160
Practice Address - Country:US
Practice Address - Phone:770-381-1273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health