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General NPI Number Information
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NPI Number | 1326889890
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Entity Type | Organization
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Legal Business Name | ELLIE MENTAL HEALTH
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 501 VILLAGE AVE STE 204
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City | YORKTOWN
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State | VA
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Zip | 23693-5657
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Country | US
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Telephone | 757-568-5904
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Fax |
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Provider Business Mailing Address
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Address Line | 501 VILLAGE AVE STE 204
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City | YORKTOWN
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State | VA
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Zip | 23693-5657
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Country | US
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Telephone | 757-568-5904
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | CHRISTIE HENNIGAN
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Credential | MS, LPC, LSATP, CSAC
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Telephone | 757-568-5904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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