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General NPI Number Information
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NPI Number | 1124440367
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Entity Type | Organization
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Legal Business Name | LINDA ELLIS, MA, LPC
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 48 HARALSON PL SUITE 3
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3087
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Country | US
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Telephone | 706-781-2661
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Fax | 706-781-2661
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Provider Business Mailing Address
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Address Line | 255 STABLE GATE DR
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-8062
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Country | US
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Telephone | 706-781-2661
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Fax | 706-781-2661
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Authorized Official
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Title or Position | LICENSED COUNSELOR
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Name | MS. LINDA ELLIS
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Credential | LPC
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Telephone | 706-781-2661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1578
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License Number State | GA
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