Individual
DAPHENE ELIJAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
870 CRESTMARK DR STE 203, LITHIA SPRINGS, GA 30122-2665
(844) 300-0102
Mailing address
1649 BRICE RD STE C, REYNOLDSBURG, OH 43068-2796
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/20/2017
Last updated
12/20/2017
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