Provider Demographics
NPI:1912192311
Name:FUNK, ELISHEVA ENDE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELISHEVA
Middle Name:ENDE
Last Name:FUNK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 RIDGELOCK CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1420
Mailing Address - Country:US
Mailing Address - Phone:770-396-7305
Mailing Address - Fax:
Practice Address - Street 1:1501 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6496
Practice Address - Country:US
Practice Address - Phone:770-933-0081
Practice Address - Fax:770-953-0807
Is Sole Proprietor?:No
Enumeration Date:2007-09-09
Last Update Date:2007-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0029591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical