Individual
ELLISEN HERNDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
250 GEORGIA AVE SE STE 206, ATLANTA, GA 30312-3000
(404) 653-0374
Mailing address
250 GEORGIA AVE SE STE 206, ATLANTA, GA 30312-3000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
05/02/2025
Last updated
05/02/2025
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