Provider Demographics
NPI:1508399239
Name:MORGAN, ELLEN
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14241 MIDLOTHIAN TPKE # 246
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6500
Mailing Address - Country:US
Mailing Address - Phone:804-426-7751
Mailing Address - Fax:
Practice Address - Street 1:5310 MARKEL RD
Practice Address - Street 2:102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3030
Practice Address - Country:US
Practice Address - Phone:804-799-7944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701006679OtherLICCENSE