Provider Demographics
NPI:1194230524
Name:KEANE, MELISSA JOY (LAPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOY
Last Name:KEANE
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8565 HAVEN WOOD TRL
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3654
Mailing Address - Country:US
Mailing Address - Phone:617-595-6440
Mailing Address - Fax:
Practice Address - Street 1:1845 PEELER RD STE D
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5710
Practice Address - Country:US
Practice Address - Phone:404-448-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional