Provider Demographics
NPI:1487839536
Name:HONDERICH, ELENI MARIA (MED, NCC)
Entity Type:Individual
Prefix:
First Name:ELENI
Middle Name:MARIA
Last Name:HONDERICH
Suffix:
Gender:F
Credentials:MED, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-4239
Mailing Address - Country:US
Mailing Address - Phone:256-259-1774
Mailing Address - Fax:256-259-0761
Practice Address - Street 1:508 GREGORY ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4239
Practice Address - Country:US
Practice Address - Phone:256-259-1774
Practice Address - Fax:256-259-0761
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51545893OtherBCBS