Provider Demographics
NPI:1477334928
Name:KOLODY, MELONY (PASTORAL COUNSELOR)
Entity Type:Individual
Prefix:
First Name:MELONY
Middle Name:
Last Name:KOLODY
Suffix:
Gender:F
Credentials:PASTORAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 NEWBURY AVE
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-4276
Mailing Address - Country:US
Mailing Address - Phone:706-339-1020
Mailing Address - Fax:
Practice Address - Street 1:2808 HILLCREEK DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6484
Practice Address - Country:US
Practice Address - Phone:706-339-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral