Provider Demographics
NPI:1750144226
Name:HIRSCH, ELLEN JANE
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:JANE
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NOVUS LN APT 227
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-6022
Mailing Address - Country:US
Mailing Address - Phone:847-372-5583
Mailing Address - Fax:
Practice Address - Street 1:1777 FORDHAM BLVD STE 204
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5885
Practice Address - Country:US
Practice Address - Phone:919-283-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health