| Doctor Name: | MRS. MARY LINDA ELLIS |
| NPI Number: | 1003964131 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.P.C. |
| License Number: | 003585 |
| Business Practice Address: | 2070 Buford Hwy Ste 2-d Buford, GA - 305186079 |
| Business Phone Number: | 7702719442 |
| Business Fax Number: | 7702718939 |
| Mailing Address: | 6120 Mapperley Ln, CUMMING |
| State: | GA |
| Postal Code: | 300416176 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/08/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 003585 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |