Provider Demographics
NPI:1962707844
Name:ELLIOTT, MARIA A (LPCC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 GRANVILLE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2967
Mailing Address - Country:US
Mailing Address - Phone:888-336-1772
Mailing Address - Fax:888-336-1772
Practice Address - Street 1:181 GRANVILLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2967
Practice Address - Country:US
Practice Address - Phone:888-336-1772
Practice Address - Fax:888-336-1772
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0701122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional