Provider Demographics
NPI:1033393798
Name:CENTER FOR EXCELLENCE
Entity Type:Organization
Organization Name:CENTER FOR EXCELLENCE
Other - Org Name:C. RICK ELLIS, ED.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:757-640-1882
Mailing Address - Street 1:4101 GRANBY ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-1117
Mailing Address - Country:US
Mailing Address - Phone:757-640-1882
Mailing Address - Fax:757-640-0253
Practice Address - Street 1:4101 GRANBY ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-1117
Practice Address - Country:US
Practice Address - Phone:757-640-1882
Practice Address - Fax:757-640-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001913103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty