Provider Demographics
NPI:1841353299
Name:HEYWOOD, ELIZABETH MCCONNELL (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MCCONNELL
Last Name:HEYWOOD
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 N NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3354
Mailing Address - Country:US
Mailing Address - Phone:704-861-9280
Mailing Address - Fax:704-868-2154
Practice Address - Street 1:905 N NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3354
Practice Address - Country:US
Practice Address - Phone:704-861-9280
Practice Address - Fax:704-868-2154
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102979Medicaid