Individual
DONIQUE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
293 INDEPENDENCE BLVD STE 400, VIRGINIA BEACH, VA 23462-5461
(757) 490-3009
Mailing address
293 INDEPENDENCE BLVD STE 400, VIRGINIA BEACH, VA 23462-5461
(757) 490-3009
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-217911
VA
Other
Enumeration date
05/26/2022
Last updated
05/26/2022
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