Individual
ELANE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3820 NINE MILE RD, RICHMOND, VA 23223-4831
(804) 365-3500
Mailing address
5089 OLD BUCKINGHAM RD, POWHATAN, VA 23139-6818
(804) 338-4840
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
05/03/2018
Last updated
05/03/2018
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