Carl R. Ellis
NPI #1114002581 in Virginia Beach, Virginia
Provider Information
- NPI Number
- 1114002581
- Entity Type
- Organization
- Organization Name
- Carl R. Ellis
- Primary Specialty
- Psychologist - Clinical Child & Adolescent
- Enumeration Date
- Oct 26, 2006
- Last Updated
- Sep 4, 2012
Practice Location
- Address
- 1020 INDEPENDENCE BLVD
- Address 2
- SUITE 204
- City
- Virginia Beach
- State
- Virginia
- ZIP Code
- 23455-5500
- Phone
- (757) 640-1882
Authorized Official
- Name
- DR. CARL RICHARD ELLIS, ED.D.
- Title
- OWNER
- Phone
- (757) 640-1882
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychologist - Clinical Child & Adolescent — Clinical Child & Adolescent |
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