Provider Demographics
NPI:1902820293
Name:ELLIOTT, ELLEN ELAINE (NCC, LCAS, LPC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:ELAINE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:NCC, LCAS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WEST THRID STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-3458
Mailing Address - Country:US
Mailing Address - Phone:336-224-0863
Mailing Address - Fax:336-238-1013
Practice Address - Street 1:9 WEST THIRD STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3458
Practice Address - Country:US
Practice Address - Phone:336-224-0863
Practice Address - Fax:336-238-1013
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4831101Y00000X
NC80318101Y00000X
NC881101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)