Provider Demographics
NPI:1285936054
Name:KORDAZAKIS, ELENI NICOLE
Entity type:Individual
Prefix:
First Name:ELENI
Middle Name:NICOLE
Last Name:KORDAZAKIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MCHENRY VILLAGE WAY
Mailing Address - Street 2:11
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4308
Mailing Address - Country:US
Mailing Address - Phone:209-526-1476
Mailing Address - Fax:209-526-0908
Practice Address - Street 1:1700 MCHENRY VILLAGE WAY
Practice Address - Street 2:11
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4308
Practice Address - Country:US
Practice Address - Phone:209-526-1476
Practice Address - Fax:209-526-0908
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional