Provider Demographics
NPI:1003092404
Name:SANTOLUCITO, ELLEN LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:LYNN
Last Name:SANTOLUCITO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 LESLIE ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-3230
Mailing Address - Country:US
Mailing Address - Phone:504-251-6277
Mailing Address - Fax:
Practice Address - Street 1:2901 RIDGELAKE DR STE 108
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4946
Practice Address - Country:US
Practice Address - Phone:504-251-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional