Provider Demographics
NPI:1801173588
Name:ELLIOTT, NATALIE ALLENE NICHOLE (LPC, LMFT, NCC, CST)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ALLENE NICHOLE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPC, LMFT, NCC, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 POWERS FERRY RD SE
Mailing Address - Street 2:BUILDING 27, STE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5491
Mailing Address - Country:US
Mailing Address - Phone:888-788-4624
Mailing Address - Fax:888-788-4624
Practice Address - Street 1:1640 POWERS FERRY RD SE
Practice Address - Street 2:BUILDING 27, STE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:888-788-4624
Practice Address - Fax:888-788-4624
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001249106H00000X
GALPC006664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist