Provider Demographics
NPI:1194506204
Name:ELLIE OF AVL CENTRAL, PLLC
Entity type:Organization
Organization Name:ELLIE OF AVL CENTRAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCENROE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:864-208-5352
Mailing Address - Street 1:77 CENTRAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2451
Mailing Address - Country:US
Mailing Address - Phone:864-208-5352
Mailing Address - Fax:
Practice Address - Street 1:77 CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2451
Practice Address - Country:US
Practice Address - Phone:864-208-5352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty