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General NPI Number Information
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NPI Number | 1548740806
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Entity Type | Individual
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Provider Name | MELISSA KAYE YOUNG
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Gender | Female
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 600 PEACHTREE PKWY STE 112
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City | CUMMING
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State | GA
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Zip | 30041
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Country | US
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Telephone | 404-432-2113
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Fax |
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Provider Business Mailing Address
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Address Line | 1527 LANDMARK LN
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City | CUMMING
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State | GA
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Zip | 30040-1898
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Country | US
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Telephone | 770-713-6572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | MSW006626
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License Number State | GA
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