Healthcare Provider Details

I. General information

NPI: 1477846186
Provider Name (Legal Business Name): CHRISTINE L. ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date: 06/11/2019
Reactivation Date: 09/26/2019

III. Provider practice location address

2014 CAPITOL AVE STE 100
SACRAMENTO CA
95811-4244
US

IV. Provider business mailing address

2014 CAPITOL AVE STE 100
SACRAMENTO CA
95811-4244
US

V. Phone/Fax

Practice location:
  • Phone: 530-776-0552
  • Fax:
Mailing address:
  • Phone: 530-776-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: