Provider Demographics
NPI:1144737388
Name:LOB, ELIMELECH (MS, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:ELIMELECH
Middle Name:
Last Name:LOB
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 GROVELAND CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5602
Mailing Address - Country:US
Mailing Address - Phone:912-429-2836
Mailing Address - Fax:
Practice Address - Street 1:7 OGLETHORPE PROFESSIONAL BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3608
Practice Address - Country:US
Practice Address - Phone:912-429-2836
Practice Address - Fax:912-352-4220
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012332101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional