Provider Demographics
NPI:1538301346
Name:ELLIOTT, LONNIE E (LPC)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:E
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25A MARSHELLEN DR
Mailing Address - Street 2:BELLEVIEW BUSINESS PARK
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6901
Mailing Address - Country:US
Mailing Address - Phone:843-522-8569
Mailing Address - Fax:843-982-6378
Practice Address - Street 1:25A MARSHELLEN DR
Practice Address - Street 2:BELLEVIEW BUSINESS PARK
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6901
Practice Address - Country:US
Practice Address - Phone:843-522-8569
Practice Address - Fax:843-982-6378
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional