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General NPI Number Information
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NPI Number | 1962527408
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Entity Type | Individual
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Provider Name | ELIZABETH MARIE POLOMIK LPC
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 8510 SIX FORKS RD SUITE 101
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City | RALEIGH
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State | NC
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Zip | 27615-3257
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Country | US
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Telephone | 919-602-8572
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Fax | 919-747-4172
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Provider Business Mailing Address
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Address Line | 3520 PRITCHARD CT
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City | RALEIGH
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State | NC
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Zip | 27616-8973
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Country | US
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Telephone | 919-266-9010
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Fax | 919-747-4172
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5135
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License Number State | NC
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