Individual
MELONEE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2325 DEER SPRINGS DR, ELLENWOOD, GA 30294-1178
(678) 459-5054
Mailing address
2325 DEER SPRINGS DR, ELLENWOOD, GA 30294-1178
(678) 459-5054
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC008052
GA
Other
Enumeration date
10/25/2018
Last updated
10/25/2018
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