Provider Demographics
NPI:1437490711
Name:BABANIN, ELLEN PAMELA (MS, NCC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:PAMELA
Last Name:BABANIN
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-4309
Mailing Address - Country:US
Mailing Address - Phone:386-307-6068
Mailing Address - Fax:
Practice Address - Street 1:324 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-4309
Practice Address - Country:US
Practice Address - Phone:386-307-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT1713106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist