Provider Demographics
NPI:1427649466
Name:ELLIS, CATHERINE PAIGE (LMSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:PAIGE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 BELLE ISLE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3301
Mailing Address - Country:US
Mailing Address - Phone:678-325-9153
Mailing Address - Fax:
Practice Address - Street 1:250 BRAY ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2203
Practice Address - Country:US
Practice Address - Phone:678-724-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0094541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical