Provider Demographics
NPI:1053149609
Name:ELLISON, CASSANDRA EMILY
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:EMILY
Last Name:ELLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 N PLUM ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2349
Mailing Address - Country:US
Mailing Address - Phone:321-848-3683
Mailing Address - Fax:
Practice Address - Street 1:1834 OREGON PIKE STE 4
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6463
Practice Address - Country:US
Practice Address - Phone:717-879-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor