Maxlyn Lavie Ellison, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

NC98-00857 Issued in NC

Practice address

2920 Highwoods Blvd
Suite 127
Raleigh, NC 27604-1015

Phone

(919) 872-5220

Fax

(919) 872-5770

NPI assigned

May 11, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Southeastern Regional Mental Health Center

  • Counselor
  • Lumberton, NC
  • NPI 1689809782
  NPD (past)
• Victoria F Lucking PLLC LCSW

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1700064375
  NPD (past)

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485302400000",
    "number": "1386859627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 REXWOODS DR",
            "address_2": "STE 102",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276073370",
            "telephone_number": "919-872-5220",
            "fax_number": "919-872-5770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 HIGHWOODS BLVD",
            "address_2": "SUITE 127",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276041015",
            "telephone_number": "919-872-5220",
            "fax_number": "919-872-5770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "MAXLYN",
        "middle_name": "LAVIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-11",
        "last_updated": "2017-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "NC98-00857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Ellison, PHARM.D.
• Jenna Ellison, PHD
• Laniya Ellison
• Logan Shontez Ellison, LCMHC
• Matthew David Ellison, M.D.
• Lawrence A. Ellsworth, MSSW, LCSW
• Patricia Ellsworth
• Wagdy Abdelmonem Elmahdy, M.D.
• Andrew Elman Elman, M.A.
• Elmore Jr DDS PLLC

• Psychiatry Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2017; 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.