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Active
Organization subpart
No

Provider details

NPI number
Authorized official
CRYSTAL DAWN ELLISON CPC (HEALTH WELLNESS SUPPORT SPECIALIST)
(313) 432-8885
Entity
Organization

Contact information

Practice address
15755 PARKWAY LN APT 1, SOUTHGATE, MI 48195-4739
(313) 432-8885
Mailing address
15755 PARKWAY LN APT 1, SOUTHGATE, MI 48195-4739
(313) 432-8885

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
07/10/2023
Last updated
04/03/2026
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