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NPI Code Detail

MEDICARE: MRS. MELISSA RENEE VELLIQUETTE LPC

MEDICARE: MRS. MELISSA RENEE VELLIQUETTE 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
1106H00000XMarriage & Family TherapistLPC110105GA

General Provider Information

NPI Number : 1336926880
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELISSA RENEE VELLIQUETTE LPC
Provider Business Mailing Address
First Line : 3652 BONNIE GLENN LN
Second Line :
City : TUCKER
State : GA
Zip : 30084-8333
Country : US
Telephone Number : 404-909-0314
Fax Number :
Provider Business Practice Location Address
First Line : 32 LENOX POINTE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30324-5699
Country : US
Telephone Number : 404-448-2080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2023
Last Update Date : 09/08/2023

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