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
- Last updated
- 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Professional Counselor
- Conyers, GA
- NPI 1699522193
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 LLC (Editions of You 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.