Provider Demographics
NPI:1750493284
Name:ELLINGTON, RONALD E (LPCC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:E
Other - Last Name:ELLINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:PO BOX 4427
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-4427
Mailing Address - Country:US
Mailing Address - Phone:575-622-2426
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST STE STE .421
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4729
Practice Address - Country:US
Practice Address - Phone:575-627-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional