Individual
ANGELIQUE ELLORIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, RBT, QMHP-T
Contact information
Practice address
780 LYNNHAVEN PKWY STE 250, VIRGINIA BEACH, VA 23452-7332
(757) 301-9065
Mailing address
212 GOLDEN MAPLE DR, VIRGINIA BEACH, VA 23452-6778
(757) 705-1829
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-172815
VA
Other
Enumeration date
06/25/2021
Last updated
06/25/2021
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