Provider Demographics
NPI:1588977466
Name:ELY, BRENDA D (LPC)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:D
Last Name:ELY
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 1:1983 LOWER ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-3348
Mailing Address - Country:US
Mailing Address - Phone:770-321-8244
Mailing Address - Fax:770-973-8844
Practice Address - Street 1:1983 LOWER ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-3348
Practice Address - Country:US
Practice Address - Phone:770-321-8244
Practice Address - Fax:770-973-8844
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002183101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor