Provider Demographics
NPI:1588440671
Name:LAMASON, ELIZABETH SIMS (APC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SIMS
Last Name:LAMASON
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:SIMS
Other - Middle Name:
Other - Last Name:LAMASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAPC
Mailing Address - Street 1:3365 SHEREE TRL
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4267
Mailing Address - Country:US
Mailing Address - Phone:404-226-1435
Mailing Address - Fax:
Practice Address - Street 1:2301 HENRY CLOWER BLVD STE A
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3152
Practice Address - Country:US
Practice Address - Phone:470-938-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA101200000X
GAAPC009242101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health