Provider Demographics
NPI:1902265242
Name:MELVIN-GUEH, KIAWATA (LPC)
Entity Type:Individual
Prefix:
First Name:KIAWATA
Middle Name:
Last Name:MELVIN-GUEH
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 1:335 VARENNA LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5755
Mailing Address - Country:US
Mailing Address - Phone:678-546-9366
Mailing Address - Fax:
Practice Address - Street 1:3883 ROGERS BRIDGE RD
Practice Address - Street 2:SUITE 204A
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2802
Practice Address - Country:US
Practice Address - Phone:609-209-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional