Healthcare Provider Details

I. General information

NPI: 1689402869
Provider Name (Legal Business Name): ELIZABETH LORRAINE MARCUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 PIERCEFIELD DR
RICHMOND HILL GA
31324-3574
US

IV. Provider business mailing address

688 PIERCEFIELD DR
RICHMOND HILL GA
31324-3574
US

V. Phone/Fax

Practice location:
  • Phone: 386-748-4663
  • Fax:
Mailing address:
  • Phone: 386-748-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-29740
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC020156
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: