Individual
DAVID JEFFREY ELLIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
318A E MAIN ST, HAVELOCK, NC 28532-2214
(252) 447-7764
(252) 444-6800
Mailing address
318A E MAIN ST, HAVELOCK, NC 28532-2214
(252) 447-7764
(252) 444-6800
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4832
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139NN
BC PROFESSIONAL COUNSELOR
NC
01
—
256439
COMPSYCH PROVIDER
NC
01
—
361114
MHN PROVIDER
NC
05
—
6102666
—
NC
Enumeration date
01/18/2006
Last updated
07/09/2007
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