Provider Demographics
NPI:1710279971
Name:UPSHAW, ZELLA MAE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ZELLA
Middle Name:MAE
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 AMBERIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-7344
Mailing Address - Country:US
Mailing Address - Phone:404-384-5482
Mailing Address - Fax:
Practice Address - Street 1:911 N TENNESSEE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8514
Practice Address - Country:US
Practice Address - Phone:404-384-5482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003111483AMedicaid