Provider Demographics
NPI:1043606221
Name:SOMBELON, ELLA RUTH (LCAS-A)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:RUTH
Last Name:SOMBELON
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 GLENDALE DR APT 15D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-6456
Mailing Address - Country:US
Mailing Address - Phone:336-686-2768
Mailing Address - Fax:
Practice Address - Street 1:1015 GLENDALE DR APT 15D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-6456
Practice Address - Country:US
Practice Address - Phone:336-686-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health