Provider Demographics
NPI:1164096376
Name:MELLS, KASHON (LPC)
Entity Type:Individual
Prefix:
First Name:KASHON
Middle Name:
Last Name:MELLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 MICKIE ANN WAY
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-8931
Mailing Address - Country:US
Mailing Address - Phone:706-871-1323
Mailing Address - Fax:
Practice Address - Street 1:2857 TOBACCO RD STE 1
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-9001
Practice Address - Country:US
Practice Address - Phone:706-871-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional