Provider Demographics
NPI:1487306205
Name:ELLIS, RUTH STRAIT (LMSW, LISW-CP, ACSW)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:STRAIT
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LMSW, LISW-CP, ACSW
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:RUTH
Other - Last Name:STRAIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6857
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29260-6857
Mailing Address - Country:US
Mailing Address - Phone:803-422-4291
Mailing Address - Fax:
Practice Address - Street 1:1825 SAINT JULIAN PL STE G6
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2431
Practice Address - Country:US
Practice Address - Phone:803-422-4291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-23
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
SC4464104100000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor