Healthcare Provider Details

I. General information

NPI: 1023938388
Provider Name (Legal Business Name): MRS. LANIYA ELLISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 CREEDMOOR RD STE 200
RALEIGH NC
27613-1711
US

IV. Provider business mailing address

7200 CREEDMOOR RD STE 200
RALEIGH NC
27613-1711
US

V. Phone/Fax

Practice location:
  • Phone: 919-912-5600
  • Fax: 800-887-8477
Mailing address:
  • Phone: 855-409-9002
  • Fax: 800-887-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: