Lisa B Ellis, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW002706 Issued in GA

Legal business name

LISA B ELLIS, LLC

Practice address

1400 Buford Hwy
Ste G7
Sugarhill, GA 30518-8721

Phone

(404) 401-7715

Fax

(770) 995-1959

NPI assigned

Nov 14, 2013

Organization subpart

No

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

Authorized official

Name

Lisa B Ellis, LCSWNPI 1700189842

Title

Owner

Phone

(404) 401-7715

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lisa Berry Ellis, LCSW

  • Clinical Social Worker
  • Buford, GA
  • NPI 1700189842
  Authorized official Same address or phone

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

{
    "created_epoch": "1384387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660694400000",
    "number": "1609206507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3635 THOMPSON MILL RD",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305195448",
            "telephone_number": "404-401-7715",
            "fax_number": "770-995-1959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BUFORD HWY",
            "address_2": "STE G7",
            "city": "SUGARHILL",
            "state": "GA",
            "postal_code": "305188721",
            "telephone_number": "404-401-7715",
            "fax_number": "770-995-1959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA B ELLIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-14",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-401-7715",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW002706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Sugar Hill, GA
• Providers in Sugar Hill, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; 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.