Healthcare Provider Details

I. General information

NPI: 1841353299
Provider Name (Legal Business Name): ELIZABETH MCCONNELL HEYWOOD PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N NEW HOPE RD
GASTONIA NC
28054-3354
US

IV. Provider business mailing address

905 N NEW HOPE RD
GASTONIA NC
28054-3354
US

V. Phone/Fax

Practice location:
  • Phone: 704-861-9280
  • Fax: 704-868-2154
Mailing address:
  • Phone: 704-861-9280
  • Fax: 704-868-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5004
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: