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General NPI Number Information
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NPI Number | 1912283508
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Entity Type | Organization
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Legal Business Name | ELIZABETH R. GLAZE, LPC, LLC
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 3504 PROFESSIONAL CIR STE A
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City | AUGUSTA
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State | GA
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Zip | 30907-8236
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Country | US
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Telephone | 706-288-5082
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Fax | 706-863-0941
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Provider Business Mailing Address
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Address Line | PO BOX 238
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City | APPLING
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State | GA
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Zip | 30802-0238
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Country | US
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Telephone | 706-288-5082
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Fax | 706-863-0941
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ELIZABETH RAY GLAZE
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Credential | LPC
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Telephone | 706-288-5082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC003774
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License Number State | GA
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