Provider Demographics
NPI:1861567778
Name:MULLINS, MELLONIE HAYES (LMFT)
Entity type:Individual
Prefix:DR
First Name:MELLONIE
Middle Name:HAYES
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SANDY SPRINGS CIR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3897
Mailing Address - Country:US
Mailing Address - Phone:404-513-9665
Mailing Address - Fax:770-483-6617
Practice Address - Street 1:333 SANDY SPRINGS CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3897
Practice Address - Country:US
Practice Address - Phone:404-513-9665
Practice Address - Fax:770-483-6617
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001040106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMFT001040OtherLICENSE