Provider Demographics
NPI:1902247638
Name:FERGUSON, MELISSA MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MICHELLE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 JOHN WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-3605
Mailing Address - Country:US
Mailing Address - Phone:404-762-9190
Mailing Address - Fax:
Practice Address - Street 1:1919 JOHN WESLEY AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-3605
Practice Address - Country:US
Practice Address - Phone:404-762-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional