Provider Demographics
NPI:1033449616
Name:ELITZ, THERESA MARIE (LPCMH, LCDP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:ELITZ
Suffix:
Gender:F
Credentials:LPCMH, LCDP
Other - Prefix:
Other - First Name:SISTER THERESA
Other - Middle Name:MARIE
Other - Last Name:ELITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCMH, LCDP
Mailing Address - Street 1:1010 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3602
Mailing Address - Country:US
Mailing Address - Phone:302-576-4121
Mailing Address - Fax:
Practice Address - Street 1:1010 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3602
Practice Address - Country:US
Practice Address - Phone:302-576-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECD0000010101YA0400X
DEPC0000252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)