Provider Demographics
NPI:1124650270
Name:LOLLEY, ELIZABETH H (MSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:H
Last Name:LOLLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 REMINGTON PL
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425
Mailing Address - Country:US
Mailing Address - Phone:850-625-2423
Mailing Address - Fax:
Practice Address - Street 1:1987 REMINGTON PL
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425
Practice Address - Country:US
Practice Address - Phone:850-625-2423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical