Ellis Counseling Services PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ELLIS COUNSELING SERVICES PLLC

Practice address

3605 Camson Rd
Fayetteville, NC 28306-3743

Phone

(910) 391-4520

NPI assigned

Oct 4, 2023

Organization subpart

No

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

Authorized official

Name

Mazie L. Ellis, LCSWANPI 1003532052

Title

Licensed Clinical Social Worker

Phone

(910) 391-4520

Specialties & licenses 2

Addresses

Other names 1

• Revive, Renew and Restore Counseling Services Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mazie Ellis, LCSWA

  • Clinical Social Worker
  • Fayetteville, NC
  • NPI 1003532052

  Addiction (Substance Use Disorder)

  NPD Authorized official

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

{
    "created_epoch": "1696377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1427838697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 CAMSON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283063743",
            "telephone_number": "910-391-4520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 CAMSON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283063743",
            "telephone_number": "910-391-4520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS COUNSELING SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-04",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "MAZIE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "910-391-4520",
        "authorized_official_credential": "LCSWA"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revive, Renew and Restore Counseling Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marquita Elliott, COUNSELOR
• Molly Elliott, DMD
• Patrick Dermico Elliott, SLP
• Teresa Elliott
• William Joseph Elliott III, PHARM.D., BCPS
• Allison Ellis, DO
• Desiree Anastashia Ellis
• Ethel J Ellis, MSN,RN
• Geertina H Ellis, HSP-PA, LPA
• Mazie Ellis, LCSWA

• Clinical Social Worker in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.