Provider Demographics
NPI:1225331796
Name:COONROD, ELAINE ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:ELIZABETH
Last Name:COONROD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 RENEE LYNN CT
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-6511
Mailing Address - Country:US
Mailing Address - Phone:919-966-4684
Mailing Address - Fax:919-966-4003
Practice Address - Street 1:CHAPEL HILL TEACCH CENTER
Practice Address - Street 2:CB# 6305
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-6305
Practice Address - Country:US
Practice Address - Phone:919-966-4684
Practice Address - Fax:919-966-4003
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3372103TC0700X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities