Provider Demographics
NPI:1245605286
Name:ELLIS, IVETTE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2587
Mailing Address - Country:US
Mailing Address - Phone:770-334-8544
Mailing Address - Fax:770-334-8656
Practice Address - Street 1:1 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2587
Practice Address - Country:US
Practice Address - Phone:770-334-8544
Practice Address - Fax:770-334-8656
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health