Provider Demographics
NPI:1619219151
Name:GERALDINE ELLIOTT LCSW COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:GERALDINE ELLIOTT LCSW COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUSBAND
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RUDY
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-760-8588
Mailing Address - Street 1:2521 ANDERSON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRESCENT SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1521
Mailing Address - Country:US
Mailing Address - Phone:859-344-9321
Mailing Address - Fax:
Practice Address - Street 1:2521 ANDERSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017-1521
Practice Address - Country:US
Practice Address - Phone:859-344-9321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty