Provider Demographics
NPI:1194208157
Name:HUBBARD, MELISSA BROWN (PHD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:BROWN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 STILESBORO RD NW STE 225
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7748
Mailing Address - Country:US
Mailing Address - Phone:800-910-5060
Mailing Address - Fax:800-630-6364
Practice Address - Street 1:5205 STILESBORO RD NW STE 225
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7748
Practice Address - Country:US
Practice Address - Phone:800-910-5060
Practice Address - Fax:800-630-6364
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0066101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty