Basic Information
| Provider Information | |||||||||
| NPI: | 1831323104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLINGSON | ||||||||
| FirstName: | SANDY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LPC, LCAS, CCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 TUNNEL RD | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288052576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282987911 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1100 TUNNEL RD | ||||||||
| Address2: | SARTP | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288052576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282987911 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2009 | ||||||||
| LastUpdateDate: | 04/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 909 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 3923 | NC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.