Provider Demographics
NPI:1881935773
Name:REID, ELYSSA (LPC, CRC, NCC)
Entity type:Individual
Prefix:
First Name:ELYSSA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:LPC, CRC, NCC
Other - Prefix:
Other - First Name:ELYSSA
Other - Middle Name:
Other - Last Name:ISHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CRC, NCC
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-0023
Mailing Address - Country:US
Mailing Address - Phone:404-800-4875
Mailing Address - Fax:
Practice Address - Street 1:333 ALCOVY ST STE 6
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2180
Practice Address - Country:US
Practice Address - Phone:706-804-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional