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General NPI Number Information
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NPI Number | 1609505213
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Entity Type | Organization
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Legal Business Name | ELLIE OF MARYLAND LLC
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 900 BESTGATE RD STE 210
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7922
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Country | US
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Telephone | 443-336-9745
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Fax |
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Provider Business Mailing Address
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Address Line | 227 PEGASUS CT
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City | GAMBRILLS
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State | MD
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Zip | 21054-1145
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Country | US
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Telephone | 443-336-9745
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. MICHAEL RICHARD STAMPER
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Credential |
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Telephone | 443-336-9745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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