Provider Demographics
NPI:1588360515
Name:ELVY, AMANDA (LAPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ELVY
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 VILLAGE PKWY NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4061
Mailing Address - Country:US
Mailing Address - Phone:770-825-0511
Mailing Address - Fax:
Practice Address - Street 1:171 VILLAGE PKWY NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4061
Practice Address - Country:US
Practice Address - Phone:770-825-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health