Provider Demographics
NPI:1154688273
Name:ELLIOT, ALEISHA MARTINE (LPC, NCC, RRT, EMDR)
Entity Type:Individual
Prefix:
First Name:ALEISHA
Middle Name:MARTINE
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:LPC, NCC, RRT, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2716
Mailing Address - Country:US
Mailing Address - Phone:706-341-4349
Mailing Address - Fax:877-876-6954
Practice Address - Street 1:908 2ND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2716
Practice Address - Country:US
Practice Address - Phone:706-341-4349
Practice Address - Fax:877-876-6954
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003140958AMedicaid