Provider Demographics
NPI:1386475804
Name:LEVERAGE, ELIZABETH LOGAN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LOGAN
Last Name:LEVERAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 PINNACLE POINT DR STE 120
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5740
Mailing Address - Country:US
Mailing Address - Phone:803-922-4008
Mailing Address - Fax:
Practice Address - Street 1:1021 PINNACLE POINT DR STE 120
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5740
Practice Address - Country:US
Practice Address - Phone:803-922-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional