| Elise Psychological Services, Llc | |
|
1330 Concord Rd Se Suite 203 Smyrna GA 30080-4375 | |
| (770) 434-4448 | |
| (770) 434-4449 |
| Full Name | Elise Psychological Services, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1330 Concord Rd Se, Smyrna, 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 4222 Chestnut Lake Ave Lithonia GA 30038-4568 Ph: (770) 434-4448 | Elise Psychological Services, Llc 1330 Concord Rd Se Suite 203 Smyrna GA 30080-4375 Ph: (770) 434-4448 |
| NPI Number | 1164654976 |
|---|---|
| Provider Enumeration Date | 08/12/2009 |
| Last Update Date | 08/12/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164654976 | NPI | - | NPPES |
| 1861554776 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC009380 (Georgia) | Primary |
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