| Doctor Name: | MARY MELTON |
| NPI Number: | 1003985243 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 1641 |
| Business Practice Address: | 1805 Herrington Rd Building 2 Lawrenceville, GA - 300435649 |
| Business Phone Number: | 7709621944 |
| Business Fax Number: | |
| Mailing Address: | 1805 Herrington Rd, Building 2 LAWRENCEVILLE |
| State: | GA |
| Postal Code: | 300435649 |
| Phone Number: | 7709621944 |
| Fax Number: | |
| NPI Enumeration Date: | 11/06/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1641 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |