Provider Demographics
NPI:1871611830
Name:KULICK, MELISSA J (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:J
Last Name:KULICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1945 MASON MILL RD
Mailing Address - Street 2:#100
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4006
Mailing Address - Country:US
Mailing Address - Phone:404-818-5819
Mailing Address - Fax:404-321-4887
Practice Address - Street 1:1945 MASON MILL RD
Practice Address - Street 2:#100
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4006
Practice Address - Country:US
Practice Address - Phone:404-818-5819
Practice Address - Fax:404-321-4887
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2335103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist