Provider Demographics
NPI:1760922140
Name:ELLIS, DION
Entity Type:Individual
Prefix:
First Name:DION
Middle Name:
Last Name:ELLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7304 RIGGS RD
Mailing Address - Street 2:APT 206
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4208
Mailing Address - Country:US
Mailing Address - Phone:240-772-8691
Mailing Address - Fax:
Practice Address - Street 1:7304 RIGGS RD
Practice Address - Street 2:APT 206
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4208
Practice Address - Country:US
Practice Address - Phone:240-772-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician