Provider Demographics
NPI:1760415517
Name:ELLIS, CYNTHIA GRAHAM (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:GRAHAM
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 TALL TREE LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3301
Mailing Address - Country:US
Mailing Address - Phone:910-799-8051
Mailing Address - Fax:
Practice Address - Street 1:3311 BURNT MILL DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2654
Practice Address - Country:US
Practice Address - Phone:910-251-5817
Practice Address - Fax:910-251-2652
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0042861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical