Provider Demographics
NPI:1447378815
Name:ELLINGTON, JOHN STEPHEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEPHEN
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 BETTE ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-5216
Mailing Address - Country:US
Mailing Address - Phone:209-623-3037
Mailing Address - Fax:209-720-0224
Practice Address - Street 1:803 COFFEE RD STE 10
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4244
Practice Address - Country:US
Practice Address - Phone:209-284-6369
Practice Address - Fax:209-720-0224
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82411041C0700X
CALCS 82411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty