Healthcare Provider Details

I. General information

NPI: 1003249277
Provider Name (Legal Business Name): ELIZABETH R CHALFANT LISW-S, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH R WHIPPLE

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SANDALWOOD DR
NEWARK OH
43055-9233
US

IV. Provider business mailing address

14 SANDALWOOD DR
NEWARK OH
43055-9233
US

V. Phone/Fax

Practice location:
  • Phone: 740-349-7511
  • Fax: 740-522-4263
Mailing address:
  • Phone: 740-788-8850
  • Fax: 740-788-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1800951-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162047
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: