Provider Demographics
NPI:1356814727
Name:SAVAGE, ECCLESIA (LPC)
Entity Type:Individual
Prefix:
First Name:ECCLESIA
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 FAIRWAYS CT STE 210
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7219
Mailing Address - Country:US
Mailing Address - Phone:678-242-9520
Mailing Address - Fax:
Practice Address - Street 1:829 FAIRWAYS CT STE 210
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7219
Practice Address - Country:US
Practice Address - Phone:678-242-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010467101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health