MEDICARE: MELISSA STONE MARTINEZ LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPC010211	GA

General Provider Information

NPI Number	:	1003393968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA STONE MARTINEZ LPC

Provider Business Mailing Address
First Line	:	175 BRADFORD SQ STE D
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-1967
Country	:	US
Telephone Number	:	678-964-6023
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 BRADFORD SQ STE D
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-1967
Country	:	US
Telephone Number	:	678-964-6023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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Directions to “ MELISSA STONE MARTINEZ LPC” Practice Location

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