Provider Demographics
NPI:1336926880
Name:VELLIQUETTE, MELISSA RENEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RENEE
Last Name:VELLIQUETTE
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 1:3652 BONNIE GLENN LN
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8333
Mailing Address - Country:US
Mailing Address - Phone:404-909-0314
Mailing Address - Fax:
Practice Address - Street 1:32 LENOX POINTE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5699
Practice Address - Country:US
Practice Address - Phone:404-448-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC110105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist