Provider Demographics
NPI:1811280977
Name:MITCHELL, MELANIE ANN (LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6032 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5447
Mailing Address - Country:US
Mailing Address - Phone:770-634-3683
Mailing Address - Fax:
Practice Address - Street 1:3121 CENTERVILLE ROSEBUD RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-5316
Practice Address - Country:US
Practice Address - Phone:404-731-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional