Provider Demographics
NPI:1457192171
Name:SHUSTER, ELIZABETH BROKAW (LCMHCA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BROKAW
Last Name:SHUSTER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 FAIRVIEW RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-2227
Mailing Address - Country:US
Mailing Address - Phone:704-584-9897
Mailing Address - Fax:
Practice Address - Street 1:6302 FAIRVIEW RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-2227
Practice Address - Country:US
Practice Address - Phone:704-584-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health