Provider Demographics
NPI:1417201609
Name:MELVIN, SUSAN G (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:G
Last Name:MELVIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 FRIAR TUCK AVE
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5403
Mailing Address - Country:US
Mailing Address - Phone:478-333-2498
Mailing Address - Fax:478-333-6531
Practice Address - Street 1:524 S HOUSTON LAKE RD STE G
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9027
Practice Address - Country:US
Practice Address - Phone:478-333-2498
Practice Address - Fax:478-333-6531
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist