Individual
ELIZABETH ELAINE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
7950 MARNE RD, FORT BENNING, GA 31905-3175
(762) 408-2610
Mailing address
7715 AURORA DR, COLUMBUS, GA 31909-1601
(915) 345-9972
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I 06307
NM
Other
Enumeration date
11/29/2006
Last updated
11/18/2014
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