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Individual
JAVIOUS ELLIS
Active
Individual
JAVIOUS ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
P014922
NC
Other
Enumeration date
05/28/2020
Last updated
01/27/2021
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