Provider Demographics
NPI:1225151582
Name:ELLEGOR, MARLEEN (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARLEEN
Middle Name:
Last Name:ELLEGOR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5587 STONINGTON TRACE PKWY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5221
Mailing Address - Country:US
Mailing Address - Phone:678-234-7678
Mailing Address - Fax:678-389-4936
Practice Address - Street 1:5587 STONINGTON TRACE PKWY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5221
Practice Address - Country:US
Practice Address - Phone:678-234-7678
Practice Address - Fax:678-389-4936
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator