| Ellie Mental Health Of Columbia | |
|
10025 Governor Warfield Pkwy Ste 206 Columbia MD 21044-3329 | |
| (727) 484-4559 | |
| Not Available |
| Full Name | Ellie Mental Health Of Columbia |
|---|---|
| Speciality | Counselor |
| Location | 10025 Governor Warfield Pkwy Ste 206, Columbia, Maryland |
| Authorized Official Name and Position | Marcus Warr (OWNER/PRESIDENT) |
| Authorized Official Contact | 3362530960 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health Of Columbia 10025 Governor Warfield Pkwy Ste 206 Columbia MD 21044-3329 Ph: () - | Ellie Mental Health Of Columbia 10025 Governor Warfield Pkwy Ste 206 Columbia MD 21044-3329 Ph: (727) 484-4559 |
| NPI Number | 1205546165 |
|---|---|
| Provider Enumeration Date | 12/01/2022 |
| Last Update Date | 08/28/2023 |
| Certification Date | 08/28/2023 |
| Medicare PECOS PAC ID | 4880042415 |
|---|---|
| Medicare Enrollment ID | O20231121000886 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205546165 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Connie Blizzard |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417142290 PECOS PAC ID: 6406168749 Enrollment ID: I20150630000561 |
| Provider Name | Ashley L Marinelli |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578141479 PECOS PAC ID: 4385094804 Enrollment ID: I20231226001500 |
| Provider Name | Gina Teranto |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215424676 PECOS PAC ID: 0244677078 Enrollment ID: I20240328000792 |
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