Provider Demographics
NPI:1922336874
Name:ELLIS, RONELLA N (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:RONELLA
Middle Name:N
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MS
Other - First Name:RONELLA
Other - Middle Name:E
Other - Last Name:FRIERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:7413 SIX FORKS RD
Mailing Address - Street 2:208
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6164
Mailing Address - Country:US
Mailing Address - Phone:919-971-9317
Mailing Address - Fax:919-710-8228
Practice Address - Street 1:8404 SIX FORKS RD
Practice Address - Street 2:201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3072
Practice Address - Country:US
Practice Address - Phone:919-971-9317
Practice Address - Fax:919-710-8228
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1292106H00000X, 103K00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health