Individual
KIMBERLY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
850 13TH ST, NEWPORT NEWS, VA 23607-6420
(754) 264-0838
(754) 264-0838
Mailing address
500 FAIRWAY DR STE 102, DEERFIELD BEACH, FL 33441-1817
(754) 264-0838
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/18/2017
Last updated
12/18/2017
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