Individual
MS. CYNTHIA SHERRON ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
281 INDEPENDENCE BLVD, SUITE 326, VIRGINIA BEACH, VA 23462-2986
(757) 490-0377
Mailing address
2909 PHEASANT WAY, CHESAPEAKE, VA 23321-6125
(757) 484-1743
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0701005219
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007770359
—
VA
01
—
680000167
MEDICARE
VA
01
—
NPPOOO
UPIN
VA
Enumeration date
06/04/2012
Last updated
06/04/2012
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