Provider Demographics
NPI:1508552993
Name:ELLIOTT, SHELLEY JO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:JO
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 LINCOLNWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-1949
Mailing Address - Country:US
Mailing Address - Phone:678-536-7281
Mailing Address - Fax:
Practice Address - Street 1:636 LINCOLNWOOD LN
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-1949
Practice Address - Country:US
Practice Address - Phone:678-536-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0085501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical