Healthcare Provider Details

I. General information

NPI: 1174324727
Provider Name (Legal Business Name): ELIZABETH HELEN BRUBAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 FALLS OF NEUSE RD # A
RALEIGH NC
27615-6804
US

IV. Provider business mailing address

6404 FALLS OF NEUSE RD
RALEIGH NC
27615-6804
US

V. Phone/Fax

Practice location:
  • Phone: 912-580-9225
  • Fax:
Mailing address:
  • Phone: 912-580-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22412
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: