Healthcare Provider Details

I. General information

NPI: 1346820909
Provider Name (Legal Business Name): ELIZABETH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 S CHERRY ST STE 400
WINSTON SALEM NC
27101-5271
US

IV. Provider business mailing address

138 S CHERRY ST STE 400
WINSTON SALEM NC
27101-5271
US

V. Phone/Fax

Practice location:
  • Phone: 336-794-6877
  • Fax:
Mailing address:
  • Phone: 336-794-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY ELIZABETH ELIZABETH DOUB
Title or Position: THERAPIST OWNER
Credential: LCMHC
Phone: 336-794-6877