Provider Demographics
NPI:1891384939
Name:WITHERS, ELIZABETH SNELLING
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SNELLING
Last Name:WITHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:COURTNEY
Other - Last Name:SNELLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SCHOOL PSYCHOLOGIST
Mailing Address - Street 1:3033 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5250
Mailing Address - Country:US
Mailing Address - Phone:678-907-9314
Mailing Address - Fax:
Practice Address - Street 1:3033 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5250
Practice Address - Country:US
Practice Address - Phone:678-907-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool