Provider Demographics
NPI:1558085324
Name:MELITO, SARA GHEESLING (LPC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:GHEESLING
Last Name:MELITO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 JOHNS CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1988
Mailing Address - Country:US
Mailing Address - Phone:678-492-8691
Mailing Address - Fax:
Practice Address - Street 1:4047 HOLCOMB BRIDGE RD STE 200-204
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-1842
Practice Address - Country:US
Practice Address - Phone:678-492-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health