| Elise Psychological Services, Llc | |
|
4222 Chestnut Lake Ave Lithonia GA 30038-4568 | |
| (770) 434-4448 | |
| (770) 434-4449 |
| Full Name | Elise Psychological Services, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 4222 Chestnut Lake Ave, Lithonia, Georgia |
| Authorized Official Name and Position | Regina Ward (OWNER) |
| Authorized Official Contact | 7704344448 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elise Psychological Services, Llc 1330 Concord Rd Se Suite Smyrna GA 30080-4373 Ph: (770) 434-4448 | Elise Psychological Services, Llc 4222 Chestnut Lake Ave Lithonia GA 30038-4568 Ph: (770) 434-4448 |
| NPI Number | 1669898987 |
|---|---|
| Provider Enumeration Date | 03/11/2014 |
| Last Update Date | 03/11/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669898987 | NPI | - | NPPES |
| 834417254A/B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC009380 (Georgia) | Primary |
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