Provider Demographics
NPI:1649795154
Name:HATZISPIROS, ELIZABETH FONDA (MA, LPCA, NCC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FONDA
Last Name:HATZISPIROS
Suffix:
Gender:F
Credentials:MA, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6535 ROLLINGRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5426
Mailing Address - Country:US
Mailing Address - Phone:678-274-7001
Mailing Address - Fax:
Practice Address - Street 1:5203 SHARON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4721
Practice Address - Country:US
Practice Address - Phone:704-554-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health