Provider Demographics
NPI:1073931523
Name:ELLIXSON, CHERYL DENISE (LPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DENISE
Last Name:ELLIXSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MARY SCOTT PL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9735
Mailing Address - Country:US
Mailing Address - Phone:336-848-1299
Mailing Address - Fax:
Practice Address - Street 1:8025 N POINT BLVD STE 209
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3296
Practice Address - Country:US
Practice Address - Phone:800-700-1606
Practice Address - Fax:866-338-5921
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10115101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional