Provider Demographics
NPI:1245549963
Name:ELIZABETH E. CORRELL, MA PLLC
Entity type:Organization
Organization Name:ELIZABETH E. CORRELL, MA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ECHEVERRIA
Authorized Official - Last Name:CORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, LCAS
Authorized Official - Phone:704-754-2050
Mailing Address - Street 1:206 JOE V KNOX AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7912
Mailing Address - Country:US
Mailing Address - Phone:704-754-2050
Mailing Address - Fax:704-662-6503
Practice Address - Street 1:206 JOE V KNOX AVE STE F
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7912
Practice Address - Country:US
Practice Address - Phone:704-754-2050
Practice Address - Fax:704-662-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105136Medicaid