Provider Demographics
NPI:1942831300
Name:ELLISON, STEPHANIE JO (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:ELLISON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5200
Mailing Address - Country:US
Mailing Address - Phone:570-337-7347
Mailing Address - Fax:
Practice Address - Street 1:5000 NEW POINT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-9411
Practice Address - Country:US
Practice Address - Phone:570-337-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008760101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional