Provider Demographics
NPI:1346054152
Name:ELLINGTON, EMMA (MA, LCMHC-A)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:MA, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 CROSSTIE LN
Mailing Address - Street 2:
Mailing Address - City:TROUTMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28166-8735
Mailing Address - Country:US
Mailing Address - Phone:704-701-0865
Mailing Address - Fax:
Practice Address - Street 1:17015 KENTON DR STE 203
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5561
Practice Address - Country:US
Practice Address - Phone:980-689-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health