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Individual
VICKIE R ELLIS
Active
Individual
VICKIE R ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904007011
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49-45573
—
VA
Enumeration date
04/08/2009
Last updated
01/04/2024
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