Healthcare Provider Details

I. General information

NPI: 1437013810
Provider Name (Legal Business Name): ELIZABETH WISE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4170 LB PROPST DR
CONOVER NC
28613-8830
US

IV. Provider business mailing address

6055 SULPHUR SPRINGS RD NE
HICKORY NC
28601-7069
US

V. Phone/Fax

Practice location:
  • Phone: 828-330-4152
  • Fax:
Mailing address:
  • Phone: 828-446-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: