Provider Demographics
NPI:1336152461
Name:ALTIZER, EVA ANN (NED LPC MHSP)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:ANN
Last Name:ALTIZER
Suffix:
Gender:F
Credentials:NED LPC MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:1570 WAVERTY RD
Practice Address - Street 2:HOLSTON COUNSELING CTR
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664
Practice Address - Country:US
Practice Address - Phone:423-224-1300
Practice Address - Fax:423-224-1375
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC1703101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
4087213OtherMAGELLAN SUMMIT
020107OtherANTHEM PROF TRIGON
368690OtherMANAGED HEALTH NET
4087213OtherMAGELLAN NAVIGATOR
020107OtherANTHEM PREF TRIGON
334969OtherVALUEOPTIONS GROUP
4087213OtherMAGELLAN PINNACLE