Provider Demographics
NPI:1174233480
Name:STANLEY, MELISSA ANN (MS, LAPC, NCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MS, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0021
Mailing Address - Country:US
Mailing Address - Phone:601-874-0498
Mailing Address - Fax:
Practice Address - Street 1:897 EVA KENNEDY RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1911
Practice Address - Country:US
Practice Address - Phone:470-484-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health