Basic Information
| Provider Information | |||||||||
| NPI: | 1952529679 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLINGTON | ||||||||
| FirstName: | RITA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PSY.D., CDCS, ADMN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4382 BISHOP CIR | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997093435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074561523 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3100 S CUSHMAN ST | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997017516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074526251 | ||||||||
| FaxNumber: | 9074564849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CDCS 2376 | AK | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 2376 | 01 | AK | ALASKA CDCS CERTIFICATION | OTHER | 1116 | 01 | AK | ST ALASKA ADMIN CERT | OTHER |