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Organization

ELLIS COUNSELING SERVICES PLLC

Active
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Organization

ELLIS COUNSELING SERVICES PLLC

Active
Other names
Revive, Renew and Restore Counseling Services
Organization subpart
No

Provider details

NPI number
Authorized official
MAZIE L. ELLIS LCSWA (LICENSED CLINICAL SOCIAL WORKER)
(910) 391-4520
Entity
Organization

Contact information

Practice address
3605 CAMSON RD, FAYETTEVILLE, NC 28306-3743
(910) 391-4520
Mailing address
3605 CAMSON RD, FAYETTEVILLE, NC 28306-3743
(910) 391-4520

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—

Other

Enumeration date
10/04/2023
Last updated
10/30/2023
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