Provider Demographics
NPI:1629853403
Name:ELLIS, VICTORIA (LMFTA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 DURHAM RD STE B
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3301
Mailing Address - Country:US
Mailing Address - Phone:919-891-0523
Mailing Address - Fax:
Practice Address - Street 1:851 DURHAM RD STE B
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3301
Practice Address - Country:US
Practice Address - Phone:919-891-0523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health