Organization
STEPHANIE LEEDY-ELLIS, PH.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE LEEDY-ELLIS PH.D. (MANAGER)
(404) 231-3364
Entity
Organization
Contact information
Practice address
3949 HOLCOMB BRIDGE RD, SUITE 200, NORCROSS, GA 30092-2207
(404) 231-3364
(770) 813-7446
Mailing address
3949 HOLCOMB BRIDGE RD, SUITE 200, NORCROSS, GA 30092-2207
(404) 231-3364
(770) 813-7446
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1688
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447346101
INDIVIDUAL PROVIDER NPI
GA
Enumeration date
05/11/2007
Last updated
08/12/2011
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