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General NPI Number Information
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NPI Number | 1386525475
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Entity Type | Organization
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Legal Business Name | ELEANOR HEALTH PROFESSIONAL
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 3455 PEACHTREE RD NE
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City | ATLANTA
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State | GA
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Zip | 30326-3254
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Country | US
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Telephone | 781-487-1107
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 386
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City | PORTSMOUTH
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State | NH
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Zip | 03802-0386
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Country | US
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Telephone | 781-487-1107
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NZINGA AJABU HARRISON
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Credential | MD
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Telephone | 617-419-0858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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