Individual
ELLIOTTNELL PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
222 SADIE MAE DR, LEXINGTON, NC 27295-7717
(203) 993-2169
Mailing address
222 SADIE MAE DR, LEXINGTON, NC 27295-7717
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810008991
VA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/25/2024
Last updated
05/07/2026
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