Provider Demographics
NPI:1639425341
Name:ELLINGTON, MACY NEIL (CADC II)
Entity type:Individual
Prefix:MR
First Name:MACY
Middle Name:NEIL
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:MACY
Other - Middle Name:NEIL
Other - Last Name:ELLINGON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC II
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-0315
Mailing Address - Country:US
Mailing Address - Phone:661-428-0333
Mailing Address - Fax:
Practice Address - Street 1:2525 N CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-1770
Practice Address - Country:US
Practice Address - Phone:661-428-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA021500116172V00000X
A021500116373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARII02700115OtherCCAPP