Provider Demographics
NPI:1326156720
Name:MONTGOMERY, ELLEN PAIGE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:PAIGE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1807 OVERLAKE DRIVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1766
Mailing Address - Country:US
Mailing Address - Phone:678-413-3833
Mailing Address - Fax:770-385-1832
Practice Address - Street 1:1807 OVERLAKE DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1766
Practice Address - Country:US
Practice Address - Phone:678-413-3833
Practice Address - Fax:770-385-1832
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional