Provider Demographics
NPI:1811912181
Name:ELLIOTT, EILEEN M (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-8019
Mailing Address - Country:US
Mailing Address - Phone:301-371-3707
Mailing Address - Fax:301-371-3706
Practice Address - Street 1:16 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-8019
Practice Address - Country:US
Practice Address - Phone:301-371-3707
Practice Address - Fax:301-371-3706
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1639101YM0800X
WV1726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health