Individual
JERMONA SHANTIA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LNSW
Contact information
Practice address
13110 CONSTITUTION AVE NE APT 622, ALBUQUERQUE, NM 87112-6153
(505) 312-7380
Mailing address
13110 CONSTITUTION AVE NE APT 622, ALBUQUERQUE, NM 87112-6153
(505) 312-7380
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
X-07204
NM
Other
Enumeration date
02/11/2011
Last updated
02/11/2011
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