Healthcare Provider Details

I. General information

NPI: 1003839317
Provider Name (Legal Business Name): SIGRID Y ELSTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2941 PIEDMONT RD NE SUITE F
ATLANTA GA
30305-2784
US

IV. Provider business mailing address

2941 PIEDMONT RD NE SUITE F
ATLANTA GA
30305-2784
US

V. Phone/Fax

Practice location:
  • Phone: 404-869-9474
  • Fax: 404-869-6421
Mailing address:
  • Phone: 404-869-9474
  • Fax: 404-869-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number002740
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: