Provider Demographics
NPI:1720487143
Name:ELLIE, CHENELLE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:CHENELLE
Middle Name:
Last Name:ELLIE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23077 THREE NOTCH RD STE 302
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-2453
Mailing Address - Country:US
Mailing Address - Phone:240-297-7849
Mailing Address - Fax:
Practice Address - Street 1:24548 BUDDS CREEK RD
Practice Address - Street 2:
Practice Address - City:CLEMENTS
Practice Address - State:MD
Practice Address - Zip Code:20624-2323
Practice Address - Country:US
Practice Address - Phone:240-297-7849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD199691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical