Provider Demographics
NPI:1285159301
Name:ELLIS, LABREYIA JAVONNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:LABREYIA
Middle Name:JAVONNE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 HENRY AVE APT G406
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-6091
Mailing Address - Country:US
Mailing Address - Phone:1484-686-0390
Mailing Address - Fax:148-468-6039
Practice Address - Street 1:7901 HENRY AVE APT G406
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-6091
Practice Address - Country:US
Practice Address - Phone:1484-686-0390
Practice Address - Fax:148-468-6039
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional