Geertina H Ellis, HSP-PA, LPA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2167 Issued in NC

Practice address

5242 Sundown Dr
Fayetteville, NC 28303-3287

Phone

(910) 670-9689

Fax

(910) 487-0703

NPI assigned

Jul 5, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Geertina Ellis Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• A4Psychology, PLLC

  • Psychologist
  • Fayetteville, NC
  • NPI 1952939811
  NPD

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1629008313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5242 SUNDOWN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283033287",
            "telephone_number": "910-578-3451",
            "fax_number": "910-487-0703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5242 SUNDOWN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283033287",
            "telephone_number": "910-670-9689",
            "fax_number": "910-487-0703"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "596 Executive Pl Ste 201",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283055189",
            "country_code": "US",
            "telephone_number": "910-578-3451",
            "fax_number": "910-487-0703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "GEERTINA",
        "middle_name": "H",
        "credential": "HSP-PA, LPA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "2167",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "NC",
            "license": "NC2167",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "84-1999514",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GEERTINA",
            "last_name": "ELLIS",
            "prefix": "DR.",
            "credential": "ED.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• William Joseph Elliott III, PHARM.D., BCPS
• Ellis Counseling Services PLLC
• Allison Ellis, DO
• Desiree Anastashia Ellis
• Ethel J Ellis, MSN,RN
• Mazie Ellis, LCSWA
• Sylvia Branson Ellis, PSY.D.
• Cierra Ellison Cruz
• Dawn Ellison
• Danielle Rae Elmore, PHARMD

• Psychologist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; 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.