1255547469 NPI number — MS. ELLEN HARRIS MARMON MS, LPC

Table of content: MS. ELLEN HARRIS MARMON MS, LPC (NPI 1255547469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255547469 NPI number — MS. ELLEN HARRIS MARMON MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARMON
Provider First Name:
ELLEN
Provider Middle Name:
HARRIS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255547469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2964 PEACHTREE RD NW
Provider Second Line Business Mailing Address:
SUITE 620
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30305-2153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-219-1679
Provider Business Mailing Address Fax Number:
404-521-4709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2964 PEACHTREE RD NW
Provider Second Line Business Practice Location Address:
SUITE 620
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30305-2153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-219-1679
Provider Business Practice Location Address Fax Number:
404-521-4709
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC005788 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com