Organization
ELISE PSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGINA WARD EDD (OWNER)
(770) 434-4448
Entity
Organization
Contact information
Practice address
1330 CONCORD RD SE, SUITE 203, SMYRNA, GA 30080-4375
(770) 434-4448
(770) 434-4449
Mailing address
4222 CHESTNUT LAKE AVE, LITHONIA, GA 30038-4568
(770) 434-4448
(770) 424-4449
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC009380
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861554776
—
GA
Enumeration date
08/12/2009
Last updated
08/12/2009
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