Individual
GEERTINA H ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HSP-PA, LPA
Contact information
Practice address
5242 SUNDOWN DR, FAYETTEVILLE, NC 28303-3287
(910) 670-9689
(910) 487-0703
Mailing address
5242 SUNDOWN DR, FAYETTEVILLE, NC 28303-3287
(910) 578-3451
(910) 487-0703
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2167
NC
103T00000X
Psychologist
NC2167
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84-1999514
—
NC
Enumeration date
07/05/2006
Last updated
04/15/2020
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