Misty Robinson Ellis

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P020742 Issued in NC

Practice address

2554 Lewisville Clemmons Rd Ste 112
Clemmons, NC 27012-9927

Phone

(336) 283-2510

NPI assigned

May 27, 2024

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

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.

• Achieving Changes Counseling Services, PLLC

  • Clinical Social Worker
  • Clemmons, NC
  • NPI 1871008672
  NPD
• West Forsyth Pain Management

  • Medical Physician Assistant
  • Clemmons, NC
  • NPI 1053692079
  NPD
• Hakuna Wellness Center LLC

  • Clinic/Center
  • New Bern, NC
  • NPI 1689217564
  NPD (past)

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

{
    "created_epoch": "1716768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1669212890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14121",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309190121",
            "telephone_number": "440-574-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2554 LEWISVILLE CLEMMONS RD STE 112",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129927",
            "telephone_number": "336-283-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBINSON ELLIS",
        "first_name": "MISTY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-27",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P020742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diego Riva
• Roach Counseling and Consultation, PLLC
• Yamuna Cleopatra Roach, LCHMC
• Zaynab Roberson
• Jodie Nicole Roberts, LCSW
• Carmen Tabrielle Robinson, M.D.
• Nicolas Edward Robinson, M.D.
• Christina Alexis Rodriguez, LCMHC-A
• Kaylyn Aileen Rodriguez
• Lina Roe, LCSW-A

• Clinical Social Worker in Clemmons, NC
• Providers in Clemmons, 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 Jun 19, 2024; 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.