Healthcare Provider Details

I. General information

NPI: 1063605558
Provider Name (Legal Business Name): ELIZABETH E INMAN M.DIV., TH.M., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 W FRIENDLY AVE
GREENSBORO NC
27410-4011
US

IV. Provider business mailing address

5003 BASS CHAPEL RD 2A
GREENSBORO NC
27455-9304
US

V. Phone/Fax

Practice location:
  • Phone: 336-508-4383
  • Fax:
Mailing address:
  • Phone: 336-508-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number64
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6589
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: