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General NPI Number Information
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NPI Number | 1467490664
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Entity Type | Individual
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Provider Name | MICHAEL S ELLWOOD PHD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 9202 CENTER OAK CT
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2744
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Country | US
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Telephone | 804-730-0432
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Fax |
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Provider Business Mailing Address
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Address Line | 9202 CENTER OAK CT STE 219
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2525
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Country | US
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Telephone | 804-730-0432
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0810001914
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 08100001914
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 0810001914
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810001914
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License Number State | VA
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