Individual
JENNA ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4030 WAKE FOREST RD STE 349, RALEIGH, NC 27609-0010
(919) 438-1626
Mailing address
4030 WAKE FOREST RD STE 349, RALEIGH, NC 27609-0010
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5608
NC
103TH0004X
Health Psychologist
5608
NC
Other
Enumeration date
07/15/2019
Last updated
03/25/2022
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