Provider Demographics
NPI:1194341487
Name:MANIGAULT, ELIZABETH (MA LPC-A)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MANIGAULT
Suffix:
Gender:F
Credentials:MA LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 KING ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-2734
Mailing Address - Country:US
Mailing Address - Phone:910-889-1708
Mailing Address - Fax:
Practice Address - Street 1:763 MEETING ST STE 200
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-3146
Practice Address - Country:US
Practice Address - Phone:910-889-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor