Provider Demographics
NPI:1700126869
Name:ELLISTON, NONAH MARIE (PHD PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:NONAH
Middle Name:MARIE
Last Name:ELLISTON
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1014 VERANDA CHASE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7178
Mailing Address - Country:US
Mailing Address - Phone:770-658-9250
Mailing Address - Fax:770-761-7734
Practice Address - Street 1:1014 VERANDA CHASE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7178
Practice Address - Country:US
Practice Address - Phone:770-658-9250
Practice Address - Fax:770-761-7734
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1810270106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist