Provider Demographics
NPI:1689442220
Name:REITER, ELIZABETH GRAHAM (LAPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GRAHAM
Last Name:REITER
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 SHORTLEAF TRL
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3364
Mailing Address - Country:US
Mailing Address - Phone:706-691-3941
Mailing Address - Fax:
Practice Address - Street 1:607 PONDER PLACE DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3186
Practice Address - Country:US
Practice Address - Phone:762-224-3027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009177101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health