Individual
LESLIE ELAINE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2005 EAGLE POINT DR, DALTON, GA 30720-4941
(727) 365-8577
Mailing address
2005 EAGLE POINT DR, DALTON, GA 30720-4941
(727) 365-8577
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
GA3273
GA
103TC0700X
Clinical Psychologist
Primary
PY7721
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
497958107C
—
GA
01
—
Z130Q
BCBSF
FL
Enumeration date
05/19/2008
Last updated
04/24/2026
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