Provider Demographics
NPI:1346584695
Name:MULVANEY, MELISSA MARIE (MAE, DIPLAC, LAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:MULVANEY
Suffix:
Gender:F
Credentials:MAE, DIPLAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 W CROSSVILLE RD
Mailing Address - Street 2:BUILDING 800, SUITE 810
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6231
Mailing Address - Country:US
Mailing Address - Phone:770-518-1785
Mailing Address - Fax:
Practice Address - Street 1:295 W CROSSVILLE RD
Practice Address - Street 2:BUILDING 800, SUITE 810
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-6231
Practice Address - Country:US
Practice Address - Phone:770-518-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA348171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist