Provider Demographics
NPI:1124835020
Name:LINEBAUGH, ELLEN (MS, CGC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:LINEBAUGH
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:106 GREGOR MENDEL CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2315
Mailing Address - Country:US
Mailing Address - Phone:864-388-1724
Mailing Address - Fax:864-941-8114
Practice Address - Street 1:106 GREGOR MENDEL CIR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2315
Practice Address - Country:US
Practice Address - Phone:864-388-1724
Practice Address - Fax:864-941-8114
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC127170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS