Provider Demographics
NPI:1689017519
Name:RICHARDS, MELINDA D (LPC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:D
Last Name:RICHARDS
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 1:3823 ROSWELL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6294
Mailing Address - Country:US
Mailing Address - Phone:678-604-7458
Mailing Address - Fax:
Practice Address - Street 1:1619 SIXTH ST UNIT 3
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2635
Practice Address - Country:US
Practice Address - Phone:340-513-1234
Practice Address - Fax:404-521-4527
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
GALPC007245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)