Healthcare Provider Details

I. General information

NPI: 1629485412
Provider Name (Legal Business Name): ELIZABETH MICHELLE ANDERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 EXECUTIVE PL FL 3
FAYETTEVILLE NC
28305-5193
US

IV. Provider business mailing address

118 SAINT GEORGE DR
RAEFORD NC
28376-6685
US

V. Phone/Fax

Practice location:
  • Phone: 910-860-7008
  • Fax: 910-221-9006
Mailing address:
  • Phone: 910-987-2180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10959
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: