Provider Demographics
NPI:1255405981
Name:ELLISON, RAMONA (LADAC)
Entity type:Individual
Prefix:MS
First Name:RAMONA
Middle Name:
Last Name:ELLISON
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:MS
Other - First Name:MOKI
Other - Middle Name:
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADAC
Mailing Address - Street 1:4301 W MARKHAM ST # 568
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-5900
Mailing Address - Fax:501-686-7150
Practice Address - Street 1:4301 W MARKHAM ST # 568
Practice Address - Street 2:SUITE 410
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-5900
Practice Address - Fax:501-686-7150
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0152101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)