Individual
MARK ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAMFT
Contact information
Practice address
2655 DALLAS HWY SW, SUITE 310, MARIETTA, GA 30064-2597
(770) 856-8393
Mailing address
2655 DALLAS HWY SW, SUITE 310, MARIETTA, GA 30064-2597
(770) 856-8393
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
AMFT000182
GA
Other
Enumeration date
01/22/2013
Last updated
01/22/2013
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