Healthcare Provider Details

I. General information

NPI: 1518355106
Provider Name (Legal Business Name): ELIZABETH KING GAYLORD LPC, LCAS, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WAKE FOREST RD STE 200
RALEIGH NC
27609-6859
US

IV. Provider business mailing address

705 CURRITUCK DR
RALEIGH NC
27609-6319
US

V. Phone/Fax

Practice location:
  • Phone: 919-437-8580
  • Fax:
Mailing address:
  • Phone: 919-437-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8958
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCA A8958
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5896
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS 3246
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: