Active NPI
Mia Ellis, LCPC
- Mental Health Counselor
- Ellicott City, MD
National Provider Identifier
1164178588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LC14726
- Practice address
- 5116 Dorsey Hall Dr
Ellicott City, MD 21042-7871 - Phone
- (443) 745-8062
- NPI assigned
- Feb 24, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LC14726 | MD | Primary |
Addresses
Primary practice location
5116 Dorsey Hall Dr
Ellicott City, MD 21042-7871
Mailing address
5116 Dorsey Hall Dr
Ellicott City, MD 21042-7871
Phone (443) 745-8062
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 10, 2025 through Nov 10, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC14726 | MD | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761868800000",
"number": "1164178588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5116 DORSEY HALL DR",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210427871",
"telephone_number": "443-745-8062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5116 DORSEY HALL DR",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210427871",
"telephone_number": "443-745-8062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "MIA",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-24",
"last_updated": "2025-10-31",
"certification_date": "2025-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MD",
"license": "LC14726",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellicott City, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.