Individual
DR. MARY ANNE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
JD,PSYD
Contact information
Practice address
133 PARK ST NE, VIENNA, VA 22180-4602
(703) 281-2657
(703) 242-0014
Mailing address
133 PARK ST NE, VIENNA, VA 22180-4602
(703) 281-2657
(703) 242-0014
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
0810004323
VA
Other
Enumeration date
10/18/2010
Last updated
10/18/2010
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