Individual
LISA BERRY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1400 BUFORD HWY, SUITE G-7, BUFORD, GA 30518-8721
(404) 401-7715
Mailing address
3635 THOMPSON MILL RD, BUFORD, GA 30519-5448
(404) 401-7715
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW002706
GA
Other
Enumeration date
12/12/2010
Last updated
08/17/2022
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