Provider Demographics
NPI:1770929242
Name:MCGREGOR, ELLEN T (LCSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:T
Last Name:MCGREGOR
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 1:710 TYRONE RD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2134
Mailing Address - Country:US
Mailing Address - Phone:814-431-2267
Mailing Address - Fax:
Practice Address - Street 1:710 TYRONE RD
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2134
Practice Address - Country:US
Practice Address - Phone:814-431-2267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0084741041C0700X
NY0351551041C0700X
PACW0165851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical