Individual
CAROLYN ILONA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
3001 ALOMA AVE STE 214, WINTER PARK, FL 32792-3752
(407) 538-7984
Mailing address
2022 PONDEROSA AVE, WINTER PARK, FL 32792-2064
(407) 538-7984
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH6728
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
763805100
—
FL
Enumeration date
06/03/2009
Last updated
06/03/2009
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