Individual
JESSICA MARIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDCIII, CADC
Contact information
Practice address
1450 MADISON AVE, COVINGTON, KY 41011-3369
(859) 444-4499
(859) 916-6713
Mailing address
419 AVON CT, CRESCENT PARK, KY 41017-1616
(859) 250-8460
(859) 916-6713
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
164249
KY
Other
Enumeration date
03/25/2019
Last updated
03/25/2019
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