Active NPI
Elise Psychological Services, LLC
- Professional Counselor
- Lithonia, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC009380
- Legal business name
- ELISE PSYCHOLOGICAL SERVICES, LLC
- Practice address
- 4222 Chestnut Lake Ave
Lithonia, GA 30038-4568 - Phone
- (770) 434-4448
- Fax
- (770) 434-4449
- NPI assigned
- Mar 11, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Regina Ward, EDD
- Title
- Owner
- Phone
- (770) 434-4448
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC009380 | GA | Primary |
Addresses
Primary practice location
4222 Chestnut Lake Ave
Lithonia, GA 30038-4568
Mailing address
1330 Concord Rd SE
Suite
Smyrna, GA 30080-4373
Phone (770) 434-4448
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 834417254A/B | Medicaid | GA |
National Provider Directory
National Provider Directory- Tax ID family
- Elise Psychological Services LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Professional Counselor
- Smyrna, GA
- NPI 1164654976
Locations
1330 Concord Rd SE
Smyrna, GA 30080
Phone (770) 315-6641
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychologist
- Decatur, GA
- NPI 1861554776
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394496000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1394496000000",
"number": "1669898987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1330 CONCORD RD SE",
"address_2": "SUITE",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300804373",
"telephone_number": "770-434-4448",
"fax_number": "770-434-4449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4222 CHESTNUT LAKE AVE",
"city": "LITHONIA",
"state": "GA",
"postal_code": "300384568",
"telephone_number": "770-434-4448",
"fax_number": "770-434-4449"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ELISE PSYCHOLOGICAL SERVICES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-03-11",
"last_updated": "2014-03-11",
"status": "A",
"authorized_official_last_name": "WARD",
"authorized_official_first_name": "REGINA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "770-434-4448",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "EDD"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC009380",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "834417254A/B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lithonia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.