Individual
MR. CHARLES WAYNE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CACI, MAC
Contact information
Practice address
199 S HERLONG AVE, ROCK HILL, SC 29732-1186
(803) 324-1800
(803) 328-3831
Mailing address
12304 JACQUELYN CT, CHARLOTTE, NC 28273-9017
(704) 575-6165
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1211149
SC
Other
Enumeration date
03/06/2013
Last updated
03/06/2013
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