Provider Demographics
NPI:1700196987
Name:RATCLIFF, MELVIN T (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:T
Last Name:RATCLIFF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9358 DEER CROSSING LK
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-8005
Mailing Address - Country:US
Mailing Address - Phone:678-773-7715
Mailing Address - Fax:
Practice Address - Street 1:9358 DEER CROSSING LK
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-8005
Practice Address - Country:US
Practice Address - Phone:678-773-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0030051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical