Provider Demographics
NPI:1194350876
Name:CAMMACK, MELISSA ANNE (LAPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:CAMMACK
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 LAKE FORREST DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3896
Mailing Address - Country:US
Mailing Address - Phone:678-274-4936
Mailing Address - Fax:
Practice Address - Street 1:6000 LAKE FORREST DR STE 200
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3896
Practice Address - Country:US
Practice Address - Phone:678-274-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health