Provider Demographics
NPI:1487705547
Name:ELLIS CONSULTING AND ASSOCIATES
Entity type:Organization
Organization Name:ELLIS CONSULTING AND ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:II
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-286-1991
Mailing Address - Street 1:4989 ROCKFISH RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8355
Mailing Address - Country:US
Mailing Address - Phone:910-848-0023
Mailing Address - Fax:910-848-0026
Practice Address - Street 1:4989 ROCKFISH RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8355
Practice Address - Country:US
Practice Address - Phone:910-848-0023
Practice Address - Fax:910-848-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301497BMedicaid
NC8301497GMedicaid
NC8301497Medicaid
NC8301497HMedicaid