Provider Demographics
NPI:1477138345
Name:ELLIS, ALEXIS J (LCSWA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:J
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 PINECREST PLAZA
Mailing Address - Street 2:BOX 270
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-4301
Mailing Address - Country:US
Mailing Address - Phone:910-660-1900
Mailing Address - Fax:
Practice Address - Street 1:875 FURR RD
Practice Address - Street 2:
Practice Address - City:VASS
Practice Address - State:NC
Practice Address - Zip Code:28394-9106
Practice Address - Country:US
Practice Address - Phone:910-660-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0159261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical