Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC005848 | GA |
NPI | 1003108374 |
---|---|
Provider Name | Ms. Carrie Lynn Elder |
First Address | Snellville, GA 30039 |
Second Address | Snellville, GA 30039-6488 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2011 |
Last Update Date | 05/05/2011 |