Provider Demographics
NPI:1356688014
Name:FLOM, ELLIOT (LAPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:ELLIOT
Middle Name:
Last Name:FLOM
Suffix:
Gender:M
Credentials:LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 SANDY PLAINS RD
Mailing Address - Street 2:BLDG 13 STE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7217
Mailing Address - Country:US
Mailing Address - Phone:770-971-9311
Mailing Address - Fax:
Practice Address - Street 1:2440 SANDY PLAINS RD
Practice Address - Street 2:BLDG 13 STE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7217
Practice Address - Country:US
Practice Address - Phone:770-971-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC 003349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health