Provider Demographics
NPI:1932319290
Name:ELLWANGER, MICHELLE HANRAHAN (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HANRAHAN
Last Name:ELLWANGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:HANRAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:42 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-6135
Mailing Address - Country:US
Mailing Address - Phone:704-462-4200
Mailing Address - Fax:704-462-4204
Practice Address - Street 1:42 3RD ST NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6135
Practice Address - Country:US
Practice Address - Phone:704-462-4200
Practice Address - Fax:704-462-4204
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCBLPC #5474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLICENSE #5474OtherNCBLPC
NCCERTIFICATE #90520OtherNBCC