| C. Rick Ellis, Ed.d. | |
|
4101 Granby St Suite 301 Norfolk VA 23504-1117 | |
| (757) 640-1882 | |
| (757) 640-0253 |
| Full Name | C. Rick Ellis, Ed.d. |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 4101 Granby St, Norfolk, Virginia |
| Authorized Official Name and Position | Carl Richard Ellis (SOLE PROPRIETOR) |
| Authorized Official Contact | 7576401882 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| C. Rick Ellis, Ed.d. 4101 Granby St Suite 301 Norfolk VA 23504-1117 Ph: (757) 640-1882 | C. Rick Ellis, Ed.d. 4101 Granby St Suite 301 Norfolk VA 23504-1117 Ph: (757) 640-1882 |
| NPI Number | 1033393798 |
|---|---|
| Provider Enumeration Date | 12/18/2007 |
| Last Update Date | 12/18/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033393798 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | 0810001913 (Virginia) | Primary |
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