Healthcare Provider Details

I. General information

NPI: 1003146499
Provider Name (Legal Business Name): ELIZABETH A URBAN MAPC, LPC, NBCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH A RICARD MAPC, LPC, NBCC

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N. RAILROAD ST
SALLEY SC
29137-9054
US

IV. Provider business mailing address

PO BOX 505
WAGENER SC
29164-0505
US

V. Phone/Fax

Practice location:
  • Phone: 803-234-1213
  • Fax:
Mailing address:
  • Phone: 803-234-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7499
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: