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General NPI Number Information
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NPI Number | 1831415900
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Entity Type | Individual
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Provider Name | ELISE RICHARD LPC, LPCS, LAC
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Gender | Female
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 3030 ASHLEY TOWN CENTER DR STE 203B
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City | CHARLESTON
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State | SC
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Zip | 29414-5678
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Country | US
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Telephone | 843-870-0278
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Fax | 843-282-7817
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Provider Business Mailing Address
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Address Line | 109 S AINSDALE DR
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City | CHARLESTON
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State | SC
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Zip | 29414-7365
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Country | US
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Telephone | 843-870-0278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5154
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License Number State | SC
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