Provider Demographics
NPI:1821121351
Name:MELTON, CHERYL S (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:S
Last Name:MELTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 N 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2602
Mailing Address - Country:US
Mailing Address - Phone:706-232-1111
Mailing Address - Fax:706-292-9042
Practice Address - Street 1:1012 N 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2602
Practice Address - Country:US
Practice Address - Phone:706-232-1111
Practice Address - Fax:706-292-9042
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist