Individual
DELORIA JEAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ALC
Contact information
Practice address
8089 HIGHWAY 72 W STE D, MADISON, AL 35758-9531
(256) 489-0025
(256) 325-0429
Mailing address
3621 PATTON RD SW APT M, HUNTSVILLE, AL 35805-4834
(334) 560-6024
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C4153A
AL
Other
Enumeration date
02/03/2023
Last updated
02/03/2023
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