Kristina Nicole Ellen, LPCA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A10093 Issued in NC

Practice address

712 Village Rd SW
Suite 106
Shallotte, NC 28470-3448

Phone

(910) 754-2273

Fax

(910) 754-2254

NPI assigned

Mar 20, 2013

Last updated

Mar 20, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Varnam Family Wellness Center, LLC

  • Family Nurse Practitioner
  • Shallotte, NC
  • NPI 1932117660
  NPD (past)

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

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363737600000",
    "number": "1588906242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 VILLAGE RD SW",
            "address_2": "SUITE 106",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284703448",
            "telephone_number": "910-754-2273",
            "fax_number": "910-754-2254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 VILLAGE RD SW",
            "address_2": "SUITE 106",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284703448",
            "telephone_number": "910-754-2273",
            "fax_number": "910-754-2254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLEN",
        "first_name": "KRISTINA",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "LPCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-20",
        "last_updated": "2013-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "A10093",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A10093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Richard Duffy, OTRL,CHT
• Paola Duran-Negron, D.C.
• Edc Drug Stores (Rite Aid Pharmacy 11528)
• Edwards Health PLLC
• Jacob Elias
• John Michael Elson, PT, DPT
• Emerald City Wellness PLLC
• Emergeortho PA
• Essman Chiropractic & Wellness Center PLLC
• Julie Ann Evans, PHARMD

• Mental Health Counselor in Shallotte, NC
• Providers in Shallotte, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; 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.