Eric Alexander Ellis, CDCA, PRS
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Ironton, OH
NPI 1225610470 · NPPES record last updated Nov 11, 2021
Key facts
- NPI
- 1225610470
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- CDCA.178795 (OH)
- Practice address
- 214 S 4TH St
Ironton, OH 45638-1610 - Phone
- (740) 532-3767
- Fax
- (740) 532-3385
- NPI assigned
- Apr 27, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CDCA.178795 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| 0002782 | OH | MD | Peer Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spectrum Outreach Services, LTD | Addiction (Substance Use Disorder) | Current |
Accepting new patients |
| Spectrum Outreach Services, LTD | Past |
Accepting new patients |
Locations
214 S 4th St
Ironton, OH 45638
Phone (740) 532-3767
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 0002782 | OH | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA.178795 | OH | Yes |
Addresses
Primary practice location
214 S 4TH St
Ironton, OH 45638-1610
Mailing address
214 S 4TH St
Ironton, OH 45638-1610
Phone (740) 532-3767
Other providers in Ironton, OH
- Kali M Elkins
- Breanna Elliott
- Kalee Ann Elliott
- Alison Ellis
- Caleb Z Ellis
- Marissa Ellis
- John Elmore
- Kenneth Elson
- Sara Emerick
- George Emery
All providers in Ironton, OH · Addiction (Substance Use Disorder) Counselor in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.