Provider Demographics
NPI:1063444693
Name:EZZELL, WINDY J (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:WINDY
Middle Name:J
Last Name:EZZELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 MILITARY CUTOFF RD STE 210
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4400
Mailing Address - Country:US
Mailing Address - Phone:910-256-3784
Mailing Address - Fax:910-256-3787
Practice Address - Street 1:1133 MILITARY CUTOFF RD STE 210
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-4400
Practice Address - Country:US
Practice Address - Phone:910-256-3784
Practice Address - Fax:910-256-3787
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC132PMOtherBCBS OF NC
NC015PFOtherBCBS OF NC GROUP NUMBER
NC6102005Medicaid