Nicole Pettis Ellis

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

270 Heritage Walk
Woodstock, GA 30188-3875

Phone

(678) 494-5700

NPI assigned

Jun 18, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Woodstock Treatment Center LLC

  • Methadone Clinic
  • Woodstock, GA
  • NPI 1508405150
  NPD
• Georgia CTC, LLC

  • Methadone Clinic
  • Dallas, GA
  • NPI 1407582042
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1336982255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 SUMMIT SPRINGS DR",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303502937",
            "telephone_number": "850-567-8964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 HERITAGE WALK",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301883875",
            "telephone_number": "678-494-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "NICOLE",
        "middle_name": "PETTIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-18",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah M Elliott, LMSW
• Raquel Elizabeth Elliott, RDN, LD
• Ashley Ellis, RBT
• Carly Ann Ellis, DC
• Genevieve Brienne Ellis, LPC
• Ashley Ellison, OT
• James David Ellner, M.D.
• Jared Paul Elms, DC
• Robert Kent Elsberry
• Glenn Richard Eltz, D.C.

• Mental Health Counselor in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.