Provider Demographics
NPI:1104293836
Name:HEFNER, ELLEN SUZANNE (MA, LPCA, NCC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:SUZANNE
Last Name:HEFNER
Suffix:
Gender:F
Credentials:MA, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 CARROLLTON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3016
Mailing Address - Country:US
Mailing Address - Phone:336-926-2143
Mailing Address - Fax:
Practice Address - Street 1:5944 CARROLLTON LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3016
Practice Address - Country:US
Practice Address - Phone:336-926-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health