Provider Demographics
NPI:1932949443
Name:ELLIS-LODMELL, ALESSANDRA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALESSANDRA
Middle Name:
Last Name:ELLIS-LODMELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 TIDAL MARSH WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-5809
Mailing Address - Country:US
Mailing Address - Phone:912-467-9538
Mailing Address - Fax:
Practice Address - Street 1:121 TIDAL MARSH WAY
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-5809
Practice Address - Country:US
Practice Address - Phone:912-467-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0091341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical