Provider Demographics
NPI:1558592105
Name:ELLIS CONSULTING AND ASSOCIATES
Entity Type:Organization
Organization Name:ELLIS CONSULTING AND ASSOCIATES
Other - Org Name:CROSSROADS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DUKE
Authorized Official - Middle Name:ELLINGTON
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:III
Authorized Official - Credentials:PSYD,LCSW
Authorized Official - Phone:910-848-0023
Mailing Address - Street 1:PO BOX 42712
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-2712
Mailing Address - Country:US
Mailing Address - Phone:910-848-0023
Mailing Address - Fax:910-848-0026
Practice Address - Street 1:912 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4737
Practice Address - Country:US
Practice Address - Phone:910-875-0287
Practice Address - Fax:910-875-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health