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1164763777
CHARLES WAYNE ELLIS
ROCK HILL, SC
NPI
1164763777
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: SC 1211149)
Enumeration Date
2013-03-06
Last Update Date
2013-03-06
Business Address
Mr. CHARLES WAYNE ELLIS CACI, MAC
199 S HERLONG AVE
ROCK HILL, SC 29732-1186
Phone number: 803-324-1800
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Mailing Address
Mr. CHARLES WAYNE ELLIS CACI, MAC
12304 JACQUELYN CT
CHARLOTTE, NC 28273-9017
Phone number: 704-575-6165
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