Healthcare Provider Details

I. General information

NPI: 1053227512
Provider Name (Legal Business Name): ELIZABETH CODY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VEAZEY DR
BUTNER NC
27509-1668
US

IV. Provider business mailing address

6405 BLAIRMORE CT
RALEIGH NC
27612-6601
US

V. Phone/Fax

Practice location:
  • Phone: 919-809-2580
  • Fax:
Mailing address:
  • Phone: 919-809-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023958
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: