Individual
MR. JOSHUA KYLE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
500 JACKSON ST, VIDALIA, GA 30474-4730
(912) 253-8003
(912) 916-0300
Mailing address
500 JACKSON ST, VIDALIA, GA 30474-4730
(912) 253-8003
(912) 916-0300
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC008312
GA
Other
Enumeration date
05/28/2015
Last updated
05/28/2015
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