Provider Demographics
NPI:1427207950
Name:BARGERON, ELLEN F (LPC)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:F
Last Name:BARGERON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HUNTINGTON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7205
Mailing Address - Country:US
Mailing Address - Phone:706-309-4670
Mailing Address - Fax:855-397-2530
Practice Address - Street 1:1 HUNTINGTON RD STE 101
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7205
Practice Address - Country:US
Practice Address - Phone:706-309-4670
Practice Address - Fax:855-397-2530
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2020-07-14
Deactivation Date:2020-05-13
Deactivation Code:
Reactivation Date:2020-07-14
Provider Licenses
StateLicense IDTaxonomies
GALPC003641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional