Provider Demographics
NPI:1659413078
Name:ELLISON, LILA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LILA
Middle Name:ELIZABETH
Last Name:ELLISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 COX ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203
Mailing Address - Country:US
Mailing Address - Phone:336-318-2757
Mailing Address - Fax:336-318-2761
Practice Address - Street 1:1207 S COX ST
Practice Address - Street 2:SUITE C
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6911
Practice Address - Country:US
Practice Address - Phone:336-318-2757
Practice Address - Fax:336-318-2761
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0026031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC408630OtherMHN
FH5000450OtherFIRST CAROLINA CARE
NC147APOtherBCBS-NC
NC6005172Medicaid
NC6005172Medicaid