Provider Demographics
NPI:1669088522
Name:SMITH, ELLEN GRYSZKA (LAPC, NCC)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:GRYSZKA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 NORTH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1525
Mailing Address - Country:US
Mailing Address - Phone:470-285-2484
Mailing Address - Fax:
Practice Address - Street 1:1330 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4373
Practice Address - Country:US
Practice Address - Phone:470-285-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health