Individual
LATISHA TAYLOR ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
106 COLONY PARK DRIVE, SUITE 500, LAWRENCEVILLE, GA 30043
(770) 294-4006
Mailing address
1785 ABINGER LN, LAWRENCEVILLE, GA 30043-3036
(770) 294-4006
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC010353
GA
101YP2500X
Professional Counselor
Primary
LPC010353
GA
Other
Enumeration date
07/08/2014
Last updated
07/31/2018
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