Provider Demographics
NPI:1285807651
Name:LANEY, ELISE JORGENSEN (LISW, LCAS, LCSW)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:JORGENSEN
Last Name:LANEY
Suffix:
Gender:F
Credentials:LISW, LCAS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 LAKESHORE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4205
Mailing Address - Country:US
Mailing Address - Phone:803-909-6363
Mailing Address - Fax:803-909-6364
Practice Address - Street 1:455 LAKESHORE PKWY
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4205
Practice Address - Country:US
Practice Address - Phone:803-909-6363
Practice Address - Fax:803-909-6364
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1268101YA0400X
SC106441041C0700X
NCC0074291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1191Medicaid