Provider Demographics
NPI:1558129783
Name:SOCKWELL, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SOCKWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZZIE
Other - Middle Name:
Other - Last Name:SOCKWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:560 BOULEVARD PL NE APT 10
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2830
Mailing Address - Country:US
Mailing Address - Phone:678-863-2765
Mailing Address - Fax:
Practice Address - Street 1:659 AUBURN AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-5412
Practice Address - Country:US
Practice Address - Phone:678-863-2765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health