Healthcare Provider Details

I. General information

NPI: 1982955902
Provider Name (Legal Business Name): MELSON COUNSELING & CONSULTING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CHAMBLEE TUCKER RD BLDG 5-300
ATLANTA GA
30341-4158
US

IV. Provider business mailing address

2900 CHAMBLEE TUCKER RD. BLDG. #5-300
ATLANTA GA
30341
US

V. Phone/Fax

Practice location:
  • Phone: 404-284-6352
  • Fax:
Mailing address:
  • Phone: 404-284-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number004455
License Number StateGA

VIII. Authorized Official

Name: DR. PATRICIA LOUISE MELSON
Title or Position: CEO
Credential: PH.D, LPC, MAC
Phone: 404-284-6352