Healthcare Provider Details

I. General information

NPI: 1679124390
Provider Name (Legal Business Name): MELONIE GRACE SINGLETON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL STE R
SANDY SPRINGS GA
30350-2995
US

IV. Provider business mailing address

8735 DUNWOODY PL STE R
SANDY SPRINGS GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 770-404-8280
  • Fax: 404-500-0498
Mailing address:
  • Phone: 404-977-1583
  • Fax: 404-500-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW008264
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMSW008912
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: