Individual provider · Type 1 NPI

Michael Mario Ellis

Addiction (Substance Use Disorder) Counselor · Stockton, CA

NPI number 1609311315 Active

Practice location

1222 Monaco Ct, #28
Stockton, CA 95207-6742

Call (209) 644-6328 Map

Fax (209) 644-6308

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XNone listed

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1609311315

Michael Mario Ellis's National Provider Identifier is 1609311315, issued on Jan 4, 2017. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Stockton, CA. The record was last updated on Jan 4, 2017.