Provider Demographics
NPI:1396950630
Name:ELLISON & ASSOCIATES OF RALEIGH PC
Entity type:Organization
Organization Name:ELLISON & ASSOCIATES OF RALEIGH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXEC OFF
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXLYN
Authorized Official - Middle Name:LAVIE
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-872-5220
Mailing Address - Street 1:2920 HIGHWOODS BLVD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1015
Mailing Address - Country:US
Mailing Address - Phone:919-872-5220
Mailing Address - Fax:919-872-5770
Practice Address - Street 1:2920 HIGHWOODS BLVD
Practice Address - Street 2:SUITE 127
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1015
Practice Address - Country:US
Practice Address - Phone:919-872-5220
Practice Address - Fax:919-872-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty