Provider Demographics
NPI:1013060565
Name:GOODWIN, MELISSA RAGSDALE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RAGSDALE
Last Name:GOODWIN
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 1:5535 SHEPHERDS POND
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7798
Mailing Address - Country:US
Mailing Address - Phone:770-262-2080
Mailing Address - Fax:770-754-4676
Practice Address - Street 1:601 BOMBAY LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5828
Practice Address - Country:US
Practice Address - Phone:770-262-2080
Practice Address - Fax:770-754-4676
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health