Provider Demographics
NPI:1447960034
Name:ELLEBIE, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ELLEBIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3638 CROWS NEST PT
Mailing Address - Street 2:
Mailing Address - City:TRIANGLE
Mailing Address - State:VA
Mailing Address - Zip Code:22172-1050
Mailing Address - Country:US
Mailing Address - Phone:571-535-6211
Mailing Address - Fax:
Practice Address - Street 1:27 JACKS SHOP RD
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:VA
Practice Address - Zip Code:22738-4061
Practice Address - Country:US
Practice Address - Phone:540-738-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician