Individual
ELLEN SUPER THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
783 CREEK GLEN RD, MABLETON, GA 30126-2797
(404) 840-8234
Mailing address
783 CREEK GLEN RD, MABLETON, GA 30126-2797
(404) 840-8234
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC011541
GA
Other
Enumeration date
02/28/2023
Last updated
02/28/2023
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