Healthcare Provider Details

I. General information

NPI: 1245549963
Provider Name (Legal Business Name): ELIZABETH E. CORRELL, MA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 JOE V KNOX AVE STE F
MOORESVILLE NC
28117-7912
US

IV. Provider business mailing address

206 JOE V KNOX AVE STE F
MOORESVILLE NC
28117-7912
US

V. Phone/Fax

Practice location:
  • Phone: 704-754-2050
  • Fax: 704-662-6503
Mailing address:
  • Phone: 704-754-2050
  • Fax: 704-662-6503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH ECHEVERRIA CORRELL
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: MA, LMFT, LCAS
Phone: 704-754-2050