Provider Demographics
NPI:1184174294
Name:PETERS, MELANIE GRAHAM (MED LPC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:GRAHAM
Last Name:PETERS
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 STONE VILLAGE LN NW STE 101
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7778
Mailing Address - Country:US
Mailing Address - Phone:224-392-8462
Mailing Address - Fax:
Practice Address - Street 1:1690 STONE VILLAGE LN NW STE 101
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7778
Practice Address - Country:US
Practice Address - Phone:224-392-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009082101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional