Individual
MS. MICHELLE M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CASAC,ICADC,CADT
Contact information
Practice address
201 E GREEN ST, SUITE 500, ITHACA, NY 14850-5635
(607) 274-6288
Mailing address
201 E GREEN ST, SUITE 500, ITHACA, NY 14850-5635
(607) 274-6288
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17385
NY
Other
Enumeration date
07/20/2012
Last updated
07/20/2012
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