Provider Demographics
NPI:1134819923
Name:PICKARD, ELEANOR ABIGAIL (LPC)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:ABIGAIL
Last Name:PICKARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3796 ASHFORD KNLS NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1866
Mailing Address - Country:US
Mailing Address - Phone:404-200-6654
Mailing Address - Fax:
Practice Address - Street 1:3796 ASHFORD KNLS NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-1866
Practice Address - Country:US
Practice Address - Phone:404-200-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional