Provider Demographics
NPI:1184759573
Name:ROBINSON GRAVES, MELISSA (LMFT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ROBINSON GRAVES
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 1:4656 KELLOGG DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4408
Mailing Address - Country:US
Mailing Address - Phone:678-982-2224
Mailing Address - Fax:
Practice Address - Street 1:4656 KELLOGG DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4408
Practice Address - Country:US
Practice Address - Phone:678-982-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist