Cynthia Sherron Ellison, L.P.C.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0701005219 Issued in VA

Practice address

281 Independence Blvd
Suite 326
Virginia Beach, VA 23462-2986

Phone

(757) 490-0377

NPI assigned

Jun 4, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Western Tidewater Community Mental

  dba Western Tidewater Community Services Board

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Suffolk, VA
  • NPI 1689615296

  Multi-Specialty

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338768000000",
    "number": "1326309535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2909 PHEASANT WAY",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233216125",
            "telephone_number": "757-484-1743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 INDEPENDENCE BLVD",
            "address_2": "SUITE 326",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234622986",
            "telephone_number": "757-490-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "CYNTHIA",
        "middle_name": "SHERRON",
        "name_prefix": "Ms.",
        "credential": "L.P.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-04",
        "last_updated": "2012-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0701005219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007770359",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "NPPOOO",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "680000167",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donique Ellis
• Kevin John Ellis, DMD
• Pamela Ellis, BS, BSN, CDCES
• Rebecca McLain Ellis, DPT
• Sara Ellis
• Traci Harp Ellison, PA-C
• Angelique Ellorin, BS, RBT, QMHP-T
• Kenneth Ross Ellul, D.C.
• Danielle Elm
• Sara Elsiddig, DDS

• Clinical Psychologist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.