Organization
ELLEN N. EMERSON, PHD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN N. EMERSON PHD (OWNER)
(912) 764-3595
Entity
Organization
Contact information
Practice address
112 N COLLEGE ST, STATESBORO, GA 30458-5309
(912) 764-3595
(912) 764-3595
Mailing address
112 N COLLEGE ST, STATESBORO, GA 30458-5309
(912) 764-3595
(912) 764-3595
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY002041
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
682757187A
—
GA
Enumeration date
06/03/2008
Last updated
06/03/2008
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