Healthcare Provider Details

I. General information

NPI: 1689017519
Provider Name (Legal Business Name): MELINDA D RICHARDS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 SIXTH ST UNIT 3
ST THOMAS VI
00802-2635
US

IV. Provider business mailing address

3823 ROSWELL RD STE 102
MARIETTA GA
30062-6294
US

V. Phone/Fax

Practice location:
  • Phone: 340-513-1234
  • Fax: 404-521-4527
Mailing address:
  • Phone: 678-604-7458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007245
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: