Provider Demographics
NPI:1144568700
Name:GOOD, MELODIE CREAGER (MA, LPC)
Entity type:Individual
Prefix:
First Name:MELODIE
Middle Name:CREAGER
Last Name:GOOD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 COLUMBIA RD STE 4D
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0403
Mailing Address - Country:US
Mailing Address - Phone:706-250-2030
Mailing Address - Fax:
Practice Address - Street 1:4210 COLUMBIA RD STE 4D
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0403
Practice Address - Country:US
Practice Address - Phone:706-250-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC7083101YP2500X
FLMH0003287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health