Provider Demographics
NPI:1376731166
Name:ELLISON, MARGARET GIBSON (EDS, LPC, MAC, CAS)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:GIBSON
Last Name:ELLISON
Suffix:
Gender:F
Credentials:EDS, LPC, MAC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BEECHVIEW DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2624
Mailing Address - Country:US
Mailing Address - Phone:404-583-9405
Mailing Address - Fax:
Practice Address - Street 1:1791 WALKER RD SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3126
Practice Address - Country:US
Practice Address - Phone:770-760-8763
Practice Address - Fax:770-760-8765
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional