Healthcare Provider Details

I. General information

NPI: 1770359887
Provider Name (Legal Business Name): ELIZABETH ANN GOWDY PHD, LISW-CP, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: E ANN GOWDY

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MCDONALD CT
MYRTLE BEACH SC
29588-6134
US

IV. Provider business mailing address

2744 W TURBEVILLE HWY
LAKE CITY SC
29560-5321
US

V. Phone/Fax

Practice location:
  • Phone: 843-294-0646
  • Fax: 843-294-0318
Mailing address:
  • Phone: 864-345-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10013
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: