Healthcare Provider Details

I. General information

NPI: 1861745986
Provider Name (Legal Business Name): BRITTANY L. ELLEDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 THOMPSON MILL RD
GAINESVILLE GA
30506-1895
US

IV. Provider business mailing address

2407 THOMPSON MILL RD
GAINESVILLE GA
30506-1895
US

V. Phone/Fax

Practice location:
  • Phone: 330-647-1258
  • Fax: 330-647-1258
Mailing address:
  • Phone: 330-647-1258
  • Fax: 330-647-1258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: