NPI | 1033393798 |
---|---|
Doing Business As | C. RICK ELLIS, ED.D. |
Entity Type | Organization |
Authorized Contact | CARL RICHARD ELLIS Sole Proprietor 757-640-1882 |
Organization Subpart ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810001913) |
Enumeration Date | 2007-12-18 |
Last Update Date | 2007-12-18 |