| Ellie Mental Health Ashburn | |
|
20755 Williamsport Pl Ste 390 Ashburn VA 20147-6523 | |
| (706) 329-8508 | |
| Not Available |
| Full Name | Ellie Mental Health Ashburn |
|---|---|
| Speciality | Counselor |
| Location | 20755 Williamsport Pl Ste 390, Ashburn, Virginia |
| Authorized Official Name and Position | Keshia Easterling (OWNER) |
| Authorized Official Contact | 7063298508 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health Ashburn 43356 Southland St Ashburn VA 20148-7556 Ph: (706) 329-8506 | Ellie Mental Health Ashburn 20755 Williamsport Pl Ste 390 Ashburn VA 20147-6523 Ph: (706) 329-8508 |
| NPI Number | 1265121024 |
|---|---|
| Provider Enumeration Date | 05/05/2023 |
| Last Update Date | 07/12/2023 |
| Certification Date | 07/12/2023 |
| Medicare PECOS PAC ID | 0547611626 |
|---|---|
| Medicare Enrollment ID | O20240112003542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265121024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Keshia M Easterling |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184201030 PECOS PAC ID: 4082065164 Enrollment ID: I20240112003724 |
| Provider Name | Lily K Spinelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407629959 PECOS PAC ID: 8729439815 Enrollment ID: I20240112003898 |
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