Provider Demographics
NPI:1154060218
Name:SAWYERS, ELLISSE KATHERINE-TRACY (LPC)
Entity Type:Individual
Prefix:
First Name:ELLISSE
Middle Name:KATHERINE-TRACY
Last Name:SAWYERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ELLISSE
Other - Middle Name:KATHERINE
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1187
Mailing Address - Country:US
Mailing Address - Phone:276-223-3200
Mailing Address - Fax:276-223-0617
Practice Address - Street 1:108 BEDWELL ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:VA
Practice Address - Zip Code:24348-9501
Practice Address - Country:US
Practice Address - Phone:276-773-3515
Practice Address - Fax:276-773-2707
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional