Provider Demographics
NPI:1619199981
Name:DAMON, ELAINE MARTIN (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARTIN
Last Name:DAMON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 EAST PACES FERRY ROAD, NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:678-665-4001
Mailing Address - Fax:
Practice Address - Street 1:455 EAST PACES FERRY ROAD, NE
Practice Address - Street 2:SUITE 203
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:678-665-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional