Individual
DEONTRAE MARQUISE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICDC
Contact information
Practice address
201 N YELLOW SPRINGS ST, SPRINGFIELD, OH 45504-2650
(833) 510-4357
(513) 881-7188
Mailing address
4600 MONTGOMERY RD STE 400, CINCINNATI, OH 45212-2600
(513) 873-1269
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LICDC.151072
OH
Other
Enumeration date
11/28/2012
Last updated
10/24/2023
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