Provider Demographics
NPI:1942825278
Name:MELLMAN, GINETTE ALEXA (LMSW)
Entity Type:Individual
Prefix:
First Name:GINETTE
Middle Name:ALEXA
Last Name:MELLMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:
Other - Last Name:MELLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1206 KAYLYN CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-5498
Mailing Address - Country:US
Mailing Address - Phone:205-492-7018
Mailing Address - Fax:
Practice Address - Street 1:1206 KAYLYN CT NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-5498
Practice Address - Country:US
Practice Address - Phone:205-492-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0084821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical