Provider Demographics
NPI:1982844700
Name:STRUGATCH, ELLEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:STRUGATCH
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 1:8150 SENTINAE CHASE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4456
Mailing Address - Country:US
Mailing Address - Phone:770-885-7599
Mailing Address - Fax:
Practice Address - Street 1:8150 SENTINAE CHASE DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4456
Practice Address - Country:US
Practice Address - Phone:770-885-7599
Practice Address - Fax:770-995-1959
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001556101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003236525AMedicaid