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General NPI Number Information
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NPI Number | 1831495225
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Entity Type | Organization
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Legal Business Name | MIDDLEWAY SYSTEMIC SOLUTIONS, PLLC
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 8404 SIX FORKS RD 201
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City | RALEIGH
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State | NC
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Zip | 27615-3072
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Country | US
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Telephone | 919-971-9317
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Fax | 919-710-8228
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Provider Business Mailing Address
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Address Line | 7413 SIX FORKS RD #208
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City | RALEIGH
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State | NC
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Zip | 27615-6164
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Country | US
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Telephone | 919-971-9317
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Fax | 919-710-8228
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Authorized Official
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Title or Position | OWNER/CLINICAL PSYCHOTHERAPIST
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Name | RONELLA ELLIS
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Credential | MS, LMFT
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Telephone | 919-971-9317
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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 | 1292
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1292
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License Number State | NC
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