Provider Demographics
NPI:1295008530
Name:THOMPSON, MELODY (LPC, NCC, BCCC)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC, NCC, BCCC
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC, BCCC
Mailing Address - Street 1:771 SUMMERSTONE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:771 SUMMERSTONE LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5429
Practice Address - Country:US
Practice Address - Phone:678-637-8643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005646101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor