Organization
SPECTRUM PSYCHOLOGICAL AND NEUROTHERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL RICHARD ELLIS ED.D. (OWNER/CEO)
(757) 640-1882
Entity
Organization
Contact information
Practice address
4542 BONNEY RD STE B, VIRGINIA BEACH, VA 23462
(757) 640-1882
(757) 640-0253
Mailing address
4542 BONNEY RD STE B, VIRGINIA BEACH, VA 23462-3867
(757) 640-1882
(757) 640-0253
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
12/11/2015
Last updated
08/15/2019
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