Provider Demographics
NPI:1669169231
Name:JEONG, ELLY YOOIL (LCSW)
Entity type:Individual
Prefix:
First Name:ELLY
Middle Name:YOOIL
Last Name:JEONG
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 1:1730 WESTFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5664
Mailing Address - Country:US
Mailing Address - Phone:212-401-2206
Mailing Address - Fax:
Practice Address - Street 1:1730 WESTFIELD CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5664
Practice Address - Country:US
Practice Address - Phone:212-401-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW008625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health