Healthcare Provider Details

I. General information

NPI: 1154111755
Provider Name (Legal Business Name): ELLE MINISTRIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 GREYSTONE DR
GUYTON GA
31312-5539
US

IV. Provider business mailing address

152 GREYSTONE DR
GUYTON GA
31312-5539
US

V. Phone/Fax

Practice location:
  • Phone: 912-410-8990
  • Fax: 912-410-8990
Mailing address:
  • Phone: 912-410-8990
  • Fax: 912-410-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LAKESHA DEAN
Title or Position: COUNSELOR
Credential:
Phone: 912-410-8990