Individual
MRS. TIERRA DOMONIQUE ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
7460 CENTRAL BUSINESS PARK DR, NORFOLK, VA 23513-2818
(757) 644-6391
(757) 622-2011
Mailing address
7460 CENTRAL BUSINESS PARK DR, NORFOLK, VA 23513-2818
(757) 644-6391
(757) 622-2011
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701012890
VA
Other
Enumeration date
09/26/2023
Last updated
10/05/2023
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