Provider Demographics
NPI:1083941892
Name:DICKINSON, MELISSA L (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2972 MEMORIAL DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-3541
Mailing Address - Country:US
Mailing Address - Phone:404-969-5139
Mailing Address - Fax:678-802-2116
Practice Address - Street 1:2972 MEMORIAL DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-3541
Practice Address - Country:US
Practice Address - Phone:404-969-5139
Practice Address - Fax:678-802-2116
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005677101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional