MEDICARE: MS. ELIZABETH BENNETT TOWNSEND M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2110	NC

General Provider Information

NPI Number	:	1356383251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH BENNETT TOWNSEND M.S.

Provider Business Mailing Address
First Line	:	3111 MAPLEWOOD AVE
Second Line	:	SUITE 105
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103-3906
Country	:	US
Telephone Number	:	336-659-8817
Fax Number	:	336-659-7799

Provider Business Practice Location Address
First Line	:	3111 MAPLEWOOD AVE
Second Line	:	SUITE 105
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103-3906
Country	:	US
Telephone Number	:	336-659-8817
Fax Number	:	336-659-7799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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