Individual
DORIAN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5470 LEMOYNE DR SW, ATLANTA, GA 30331-9206
(617) 331-6966
Mailing address
3645 MARKETPLACE BLVD STE 130-171, ATLANTA, GA 30344-5747
(470) 222-5354
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
007688
GA
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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