Provider Demographics
NPI:1003839317
Name:ELSTON, SIGRID Y (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIGRID
Middle Name:Y
Last Name:ELSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 PIEDMONT RD NE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2784
Mailing Address - Country:US
Mailing Address - Phone:404-869-9474
Mailing Address - Fax:404-869-6421
Practice Address - Street 1:2941 PIEDMONT RD NE
Practice Address - Street 2:SUITE F
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2784
Practice Address - Country:US
Practice Address - Phone:404-869-9474
Practice Address - Fax:404-869-6421
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002740103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10040636OtherAMERIGROUP
GA179184200AMedicaid
GAN326975OtherWELLCARE
GA200256766OtherMENTAL HEALTH NET
GA20026766OtherPEACHSTATE
GA52703914-001OtherBLUE CROSS BLUE SHIELD