Provider Information for 1588890677
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CAROLYN ILONA ELLIS LMHC
Sex: Female
NPI: 1588890677
Last Updated: 2009-06-03
Certification Date:
Certification Date:
Details
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| NPI | 1588890677 | ||||||||
| Enumeration Date | 2009-06-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2022 PONDEROSA AVE WINTER PARK, FL 32792-2064 United States Phone: 407-538-7984 | Fax: | ||||||||
| Primary Practice Address | 3001 ALOMA AVE STE 214 WINTER PARK, FL 32792-3752 United States Phone: 407-538-7984 | Fax: | ||||||||
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