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NPI Code Detail

MEDICARE: ELIZABETH KING GAYLORD LPC, LCAS, CCS

MEDICARE:   ELIZABETH KING GAYLORD  LPC, LCAS, CCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorLPCA A8958NC
2101YA0400XAddiction (Substance Use Disorder) CounselorLCAS 3246NC
3101YM0800XMental Health Counselor8958NC

General Provider Information

NPI Number : 1518355106
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH KING GAYLORD LPC, LCAS, CCS
Provider Business Mailing Address
First Line : 705 CURRITUCK DR
Second Line :
City : RALEIGH
State : NC
Zip : 27609-6319
Country : US
Telephone Number : 919-437-8580
Fax Number :
Provider Business Practice Location Address
First Line : 4000 WAKE FOREST RD STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27609-6859
Country : US
Telephone Number : 919-437-8580
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2015
Last Update Date : 07/21/2022

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