Individual
ELLYCE DIANA PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, NCC, LAPC
Contact information
Practice address
6095 PINE MOUNTAIN RD NW STE 105, KENNESAW, GA 30152-3332
(678) 217-7529
(770) 966-8228
Mailing address
2743 FAIRFIELD DR SW, MARIETTA, GA 30064-3721
(678) 522-7832
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
005656
GA
Other
Enumeration date
05/30/2017
Last updated
05/30/2017
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