Provider Demographics
NPI:1477286508
Name:EL, YSSIS
Entity Type:Individual
Prefix:
First Name:YSSIS
Middle Name:
Last Name:EL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 N BERKELEY LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3006
Mailing Address - Country:US
Mailing Address - Phone:470-704-5031
Mailing Address - Fax:
Practice Address - Street 1:3390 N BERKELEY LAKE RD NW
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3006
Practice Address - Country:US
Practice Address - Phone:470-704-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical