Provider Demographics
NPI:1780093054
Name:ELLERBE, MICHELLE YVETTE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YVETTE
Last Name:ELLERBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 GIN MILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-7279
Mailing Address - Country:US
Mailing Address - Phone:910-544-8343
Mailing Address - Fax:
Practice Address - Street 1:181 GIN MILL RD
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-7279
Practice Address - Country:US
Practice Address - Phone:910-544-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC463820592Medicaid
GA463820592Medicaid
SC463820592Medicaid