Provider Demographics
NPI:1376809228
Name:PELLEGRINO, LILLIAN (LPC)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:PELLEGRINO
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 1:2566 SHALLOWFORD RD NE STE 104
Mailing Address - Street 2:PMB 324
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1200
Mailing Address - Country:US
Mailing Address - Phone:770-458-0450
Mailing Address - Fax:770-458-0470
Practice Address - Street 1:2150 PEACHFORD RD
Practice Address - Street 2:SUITE K
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6520
Practice Address - Country:US
Practice Address - Phone:770-458-0450
Practice Address - Fax:770-458-0470
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional