Tierra Domonique Ellison, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0701012890 Issued in VA

Practice address

7460 Central Business Park Dr
Norfolk, VA 23513-2818

Phone

(757) 644-6391

Fax

(757) 622-2011

NPI assigned

Sep 26, 2023

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Compass Youth Services

  • Community/Behavioral Health Agency
  • Norfolk, VA
  • NPI 1952339046
  NPD (past)

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

{
    "created_epoch": "1695686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1912786393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7460 CENTRAL BUSINESS PARK DR",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235132818",
            "telephone_number": "757-644-6391",
            "fax_number": "757-622-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7460 CENTRAL BUSINESS PARK DR",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235132818",
            "telephone_number": "757-644-6391",
            "fax_number": "757-622-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "TIERRA",
        "middle_name": "DOMONIQUE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-26",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0701012890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carl Richard Ellis, ED.D.
• Nicole Ellis, DPT
• Rachel Ellis, PA-S
• Rebecca Ellis, LCSW
• Lisa Marie Ellison, MA, LMT
• Enas Elmaghrbi, D.M.D
• Moataz Nasser Elmahdy, DDS
• Kelly A Elmhorst, CRNA, DNAP
• Peter Richard Elser, MSPT
• Karen E. Elseroad, L.C.S.W.

• Mental Health Counselor in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Mental Health Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.