Provider Demographics
NPI:1144350265
Name:MELTON, DOROTHY LEE (LMSW)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LEE
Last Name:MELTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:LEE
Other - Last Name:GREER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1125 EGMONT ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-7331
Mailing Address - Country:US
Mailing Address - Phone:912-279-0150
Mailing Address - Fax:
Practice Address - Street 1:3045 SCARLETT ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1251
Practice Address - Country:US
Practice Address - Phone:912-554-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW004170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health