Provider Demographics
NPI:1518625649
Name:ELLISON, SARA (APC, NCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ELLISON
Suffix:
Gender:F
Credentials:APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 AUBURN AVE NE APT 228
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1980
Mailing Address - Country:US
Mailing Address - Phone:310-562-7053
Mailing Address - Fax:
Practice Address - Street 1:659 AUBURN AVE NE APT 228
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1980
Practice Address - Country:US
Practice Address - Phone:310-562-7053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008314101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional