Provider Demographics
NPI:1679124390
Name:SINGLETON, MELONIE GRACE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELONIE
Middle Name:GRACE
Last Name:SINGLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 RIVER RUN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-7205
Mailing Address - Country:US
Mailing Address - Phone:404-977-1583
Mailing Address - Fax:
Practice Address - Street 1:3925 HARRISON RD STE 100
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-5898
Practice Address - Country:US
Practice Address - Phone:770-676-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW008912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health