Active NPI
Angela Leslie Ellis, LPC
- Professional Counselor
- Tucker, GA
National Provider Identifier
1306070958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC005488
- Practice address
- 100 Crescent Center Pkwy
Suite 1290
Tucker, GA 30084-7060 - Phone
- (770) 621-0479
- Fax
- (770) 621-0466
- NPI assigned
- May 12, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC005488 | GA | Primary |
Addresses
Primary practice location
100 Crescent Center Pkwy
Suite 1290
Tucker, GA 30084-7060
Mailing address
2561 Rainover CT
Decatur, GA 30034-2264
Phone (404) 288-3759
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC005488 | GA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Serenityinc7, LLC | Professional | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242086400000",
"number": "1306070958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2561 RAINOVER CT",
"city": "DECATUR",
"state": "GA",
"postal_code": "300342264",
"telephone_number": "404-288-3759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 CRESCENT CENTER PKWY",
"address_2": "SUITE 1290",
"city": "TUCKER",
"state": "GA",
"postal_code": "300847060",
"telephone_number": "770-621-0479",
"fax_number": "770-621-0466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "ANGELA",
"middle_name": "LESLIE",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-12",
"last_updated": "2009-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC005488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
- Editions of You Psychotherapy & Art Therapy
- Rebecca L Eisman, P.T., C.H.T.
- Roselyn Angel Ekperi, CPNP-PC
- Elite Medical Physicians PC
- Bruenetter Ellis Wright, ADDICTION COUNSELOR
- Louisa Carns Ellis, LCSW
- Raven Ifoma Elosiebo-Walker, M.D.
- Rebekah M Elting, RN
- Emory Physical Therapy, LLC
- Edwynta Engles
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.